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COMPARISON OF TWO METHODS IN ESTIMATING THE RELATION

BETWEEN DENTAL AGE AND CHRONOLOGICAL AGE

A Dissertation submitted in

partial fulfillment of the requirements

for the degree of

MASTER OF DENTAL SURGERY

BRANCH – IX

ORAL MEDICINE AND RADIOLOGY

THE TAMILNADU Dr.M.G.R.MEDICAL UNIVERSITY

CHENNAI- 600032

2015-2018

DECLARATION

TITLE OF DISSERTATION

COMPARISON OF TWO METHODS

IN ESTIMATING THE RELATION

BETWEEN DENTAL AGE AND

CHRONOLOGICAL AGE

PLACE OF STUDY

K.S.R .Institute of Dental Science and

Research

DURATIONOF COURSE 3 Years

NAME OF THE GUIDE Dr.Nazargi Mahabob

HEAD OF THE DEPARTMENT Dr.(Capt) S.Elangovan

I hereby declare that no part of the dissertation will be utilized for gaining

financial assistance for research or other promotions without obtaining prior

permission of the Principal, K.S.R. Institute of Dental Science and Research,

Tiruchengode. In addition, I declare that no part of this work will be published

either in print or electric without the guide who has been actively involved in the

dissertation. The author has the right to reserve publishing of work solely with

prior permission of the Principal, K.S.R. Institute of Dental Science and Research,

Tiruchengode.

Head of the Department Guide Signature of the Candidate

CERTIFICATE BY THE GUIDE

This is to certify that dissertation titled “COMPARISON OF TWO

METHODS IN ESTIMATING THE RELATION BETWEEN DENTAL AGE

AND CHRONOLOGICAL AGE” is a bonafide research workdone by

Dr.G.SURYA in partial fulfillment of the requirements for the degree of

MASTER OF DENTAL SURGERY in the speciality of ORAL MEDICINE

AND RADIOLOGY.

Date :

Place :

Signature of H.O.D Signature of Guide

DR.(CAPT).S.ELANGOVAN.,M.D.S. DR.NAZARGI MAHABOB.,M.D.S.

PROFESSOR AND H.O.D PROFESSOR

ENDORSEMENT BY THE H.O.D,PRINCIPAL/HEAD OF THE

INSTITUTION

This is to certify that Dr.G.SURYA, Post Graduate student (2015-2018) in the

Department of Oral Medicine and Radiology, K.S.R Institute of Dental Science

and Research, has done this dissertation titled “COMPARISON OF TWO

METHODS IN ESTIMATING THE RELATION BETWEEN DENTAL AGE

AND CHRONOLOGICAL AGE” under our guidance and supervision in partial

fulfillment of the regulations laid down by the Tamilnadu Dr.M.G.R.Medical

University,Chennai-600032 for M.D.S.,(Branch-IX) Oral Medicine and

Radiology degree examination.

Seal & Signature of H.O.D Seal & Signature of Principal

DR.(CAPT).S.ELANGOVAN.,M.D.S Dr.G.S.KUMAR.,M.D.S.

PROFESSOR AND H.O.D PRINCIPAL

ACKNOWLEDGEMENT

I am extremely grateful to my guide, Dr. Nazargi Mehabob M.D.S, Reader ,

Department of Oral Medicine and Radiology , KSR Institute of Dental Sciences and

Research, Tiruchengode for inspiring me to choose this topic. His meticulous guidance,

encouragement and eye for perfection, made my work easier and complete. His unending

belief in me was the key element which helped me to bring out the best in me.

I would most humbly like to thank my Head of the Department, Dr. (Capt)

S.Elangovan M.D.S., Professor , Department of Oral Medicine and Radiology , KSR

Institute of Dental Sciences and Research, Tiruchengode whose invaluable guidance have

instilled the confidence and determination in me to strive for my perfection.

I take this opportunity to express my humble gratitude to Dr.G.S.Kumar,

Principal, K.S.R. Institute of Dental Science and Research for his permission and

encouragement.

I want to express my deepest thanks to Dr.Suman M.D.S., Professor , Department

of Oral Medicine and Radiology , KSR Institute of Dental Sciences and Research, for her

tremendous help and guidance. Her constant supervision, motivation and support enabled me

to successfully complete my dissertation and realizing my goal in time. Her words can always

inspire me and bring me to a higher level of thinking.

It is my pleasure to express my deep thankfulness to Dr. Senthil Kumar M.D.S.,

Reader, Department of Department of Oral Medicine and Radiology , KSR Institute of

Dental Sciences and Research, for his motivation, encouragement and valuable advice at

times in need during the course of my work.

I thank Dr. Deepika Rajendran M.D.S., Senior Lecturer and Dr. Gomathi

M.D.S., Senior Lecturer,Department of Oral Medicine and Radiology , KSR Institute of

Dental Sciences and Research, for her support and encouragement.

Words are nothing but a medium to express my profound thanks to Dr.Sharmila

Shanmuganathan for their untiring stint of moral support, encouragement , and help.

My heartfelt appreciation to all my dear seniors, my juniors and colleagues for

their support during the period of my work.

I am thankful to Dr.Prakash M.D.S., Department of Community Dentistry,K.S.R.

Institute of Dental Science and Research,for the Biostatistics work.

I feel so blessed to have such a wonderful family and who make it a point to

remind me that I’m special to them. I owe a lot to my parents, my sister who encouraged

and helped me at every stage of my personal and academic life, and longed to see this

achievement come true.

CONTENTS

S.NO

TITLE

PAGE NO.

1

INTRODUCTION

1

2

AIMS AND OBJECTIVES

7

3

REVIEW OF LITERATURE

9

4

MATERIALS AND METHODS

31

5

STATISTICAL ANALYSIS

45

6

RESULTS

47

7

DISCUSSION

73

8

SUMMARY AND CONCLUSION

80

9

BIBLIOGRAPHY

83

10

ANNEXURE

91

LIST OF FIGURES

S.NO

TITLE

PAGE NO

1

Digital Panoramic System : SIRONA-

ORTHOPHOS X G

39

2

Dental Radiograph Machine – Carestream Dental

40

3

Dental Intra Oral Xray Film

41

4

Dentsply Rinn Holder

41

5

Automatic Processor

42

6

Armamentarium for Tracing Radiograph

42

7

Tooth Length

43

8

Pulp Length

43

9

Root Length

44

10

Width of the Pulp At Cemento-enamel Junction

44

LIST OF TABLES

S.NO

TITLE

PAGE NO

1

DESCRIPTIONS OF STAGES OF TOOTH DEVELOPMENT OF

DEMIRJIAN ET AL., METHOD

36

2

DEVELOPMENTAL STATUS OF A PARTICULAR TOOTH BY

WILLEMS ET AL.,METHOD

38

3

DISTRIBUTION OF THE SUBJECTS BY THEIR AGE AND

GENDER

48

4

ILLUSTRATING THE RESULTS OBTAINED FROM KVAAL’S

METHOD (GROUP 1)

49

5


METHOD (GROUP 2)

50

6


METHOD (GROUP 3)

51

7


METHOD (GROUP 4)

52

8


METHOD (GROUP 5)

53

9

DEVELOPMENTAL STAGES OF EACH OF THE RIGHT

MANDIBULAR TEETH FOR GROUP I

54

10

DEVELOPMENTAL STAGES OF EACH OF THE

RIGHT MANDIBULAR TEETH FOR GROUP II

55

11


MANDIBULAR TEETH FOR GROUP III

56

12


MANDIBULAR TEETH FOR GROUP IV

57

13


MANDIBULAR TEETH FOR GROUP V

58

14

ILLUSTRATING THE RESULTS OBTAINED FROM

WILLEM’S METHOD (GROUP 1)

59

15



60

16



61

17



62

18



63

19

MEAN AND SD OF DIFFERENT AGE ESTIMATION

METHODS OF DIFFERENT AGE GROUPS

64

20

DESCRIPTIVE STATISTICS OF TWO AGE ESTIMATION

METHODS

65

21

CONFIDENCE INTERVAL FOR DIFFERENT AGE

ESTIMATION METHODS

66

22

MEAN AGE OF DIFFERENT AGE ESTIMATION METHODS

BY GENDER

67

23

MEAN DIFFERENCES AND STANDARD ERROR

DIFFERENCES OF DIFFERENT AGE ESTIMATION METHODS

68

CHARTS

S.NO TITLE PAGE NO.

1

Distribution of the subjects by their age and

gender

69

2

Mean chronological age of different age groups

69

3

Mean estimated dental age of different age

groups by Willem’s method

70

4


groups by Kvaal’s method

70

5


groups by different age estimation methods

71

6

Mean age of males by different age estimation

methods

72

7

Mean age of males by different age estimation

methods

72

INTRODUCTION

INTRODUCTION

Page 1

Personal identification is becoming increasingly important not only in legal medicine

but also in criminal investigation, identification and Genetic Research.1It is an important

basis for differentiating guilty from innocent in legal issues, for ethical issues and for

declaration of death reports and the basis for probing into criminal cases, mass disaster or

war victims.2

The mouth has been identified as the organ system “where it all begins.” Forensic

odontology, or forensic dentistry, was defined by Keiser- Neilson in 1970 as “a branch of

forensic medicine which in the interest of justice deals with the proper handling and

examination of dental evidence and with the proper evaluation and presentation of the dental

findings.”3

Dr. Oscar Amoedo was considered as the father of the forensic odontologist. The thesis

done by him entitled ‘L’ Art Dentaire en Medicine Leagale’ to the faculty of medicine earned

him a doctorate. This book is the first comprehensive text on forensic odontologist.4

The traditional methods of personal identification include anthropometry, finger prints,

sex determination, estimation of age, measurement of height, identification of a specific

individual, and differentiation by blood groups.5 The accurate estimation of age at the time of

death with the help of dental remains is an important parameter for identification. 2

Age plays an important role in various fields such as forensic science, various social

and legal settings and treatment planning in clinical dentistry.6 The age of a person can be

determined by the degree of maturation of the different tissue systems of an individual.

INTRODUCTION

Page 2

In 1889, Laccasagne was the first to use changes in the teeth of adults to estimate

age.8 Later, Bodecker, in 1925, pointed out that some morphological changes in teeth could

be related to increasing age.9

Literature reports different morphological and radiological techniques for age

assessment. Dental age estimation has gained acceptance because it is less variable when

compared to other skeletal and sexual maturity indicators.10 Examination of teeth in many

ways form a unique part of human body, as they are the most durable and resilient part of the

skeleton.11At times teeth are the only means of identification when the dead bodies have

under gone changes so extensive, that external characteristics yield little information.12

Adult teeth consists of enamel as the outermost covering of tooth crown and dentin

underneath, both of which are hard tissues resistant to decomposition, followed by pulp as

the innermost soft tissue core. Likewise cementum is the outermost covering for the surface

of root which is also resistant to decomposition. 2

Dental age (DA) determination is important because it is a useful tool to estimate the

CA of a child with an unknown birth date. Teeth are among the most reliable tools in the

process of identification of age, especially in the first and second decades. The stages of

development can be considered as one of the most dependable indicators in assessing the age

of the victim.13

INTRODUCTION

Page 3

Dental Age Estimation Methods 14

Various methods are utilized for determination of age from dentition. Dental age assessment

methods may be classified as:

A. According to the state of development of the dentition:

Methods applied to the forming dentition

Methods for the adult fully formed dentition.

B. According to the technique of investigation:

Clinical or visual

Radiographic

Histological

Physical and chemical analysis

i. Clinical or visual method: Visual observation of the stage of eruption of the teeth and

evidence of changes due to function such as attrition can give an approximate estimate of

age.

ii. Radiographic method: Radiography can provide the gross stage of dental development of

the dentition.

INTRODUCTION

Page 4

iii. Histological method: Histological methods require the preparation of the tissues for

detailed microscopic examination, which can determine more accurately the stage of

development of the dentition. This technique is more appropriate for postmortem situations.

It is also significant in estimation of age of early development of dentition.

iv. Physical and chemical analysis: The physical and chemical analysis of dental hard

tissues to determine alterations in ion levels with age have been proposed. While these

techniques, as yet, are not of great value to the forensic odontologist, future developments

might provide an adjunctive means of collecting evidence of value in the dental context.

Age estimation using the dentition can be grouped into 3 phases(15-21)

1. Age estimation in prenatal, neonatal and early postnatal child

2. Age estimation in children and adolescents

3. Age estimation in adults

INTRODUCTION

Page 5

1. Age estimation in prenatal, neonatal and early postnatal child

- Age assessment from the neonatal line

- Age assessment based on thickness of enamel and dentin from the neonatal line

-Age assessment from the incremental lines

-Age assessment from the weight of the development dentition

2. Age estimation of children and adolescents

-Age estimation using charts prepared from population surveys

-Age assessment by examination of the incremental pattern of tooth formation

-Third molars in age estimation

3. Estimation of age in adults

-Gustafson’s method

-Age estimation using color of the teeth

-Age estimation using fluorescence from dentine and cementum

-Age estimation in dental pulp DNA based on human telomere shortening

- Radiographic method

AIMS AND OBJECTIVES

AIMS AND OBJECTIVES

Page 7

To determine dental age by radiographic methods in Digital Orthopantamograph

using Willem’s method and in Intra oral periapical radiograph using Kwaal’s method

To find out the accuracy of two methods in determining the relation between dental

age and chronological age


Page 9

Sigrid I.Kvaal et al (1995) 22 conducted study using 100 periapical radiographs which were

taken using paralleling technique and the samples were collected from clinics of dental

faculty in Oslo. The age ranging from 20-87 years were included in the study. Tooth / root

length, the pulp /root length, as well as the pulp/root width at three levels were calculated

from the radiographs of maxillary central and lateral incisors and second premolars, and

mandibular lateral incisors, canines and from first premolars by using Vernier calipers. All

five ratios had significant influence on age except the ratio between length of tooth and root.

The coefficient of determination (r2) for the regression was strongest when the ratios from all

six types of teeth from both jaws were employed.

Andrea G.Drusini et al (1997) 23 examined panoramic radiographs of 425 premolars and

421 molars to measure the coronal height and the height of coronal pulp cavity and 100 teeth

from 100 year old skeletons. For panoramic study,213 males and 220 females of known age

ranging from 9-76 years were included. Correlations were slightly higher in males than

females with an error of +5 years in 81.4% of cases. In historical sample, error of +5 years in

70.37% of cases of molars. It was found that this method can be applied to estimate the age

in both living individuals and skeletal material of unknown age.

Kolltveit and Solheim et al.(1998) 24 had conducted a study to compare the reliability of

manual measurements (vernier calipers using a stereomicroscope) with that of computer-

assisted measurements (CAM) of morphological parameters using Image analysis software in


Page 10

dental radiographs. Ratios calculated from the linear measurements of “tooth” by “pulp”

showed a weaker correlation with age when the image analysis program was employed than

did ratios based on conventional measurements (without image analysis) of the same. The

main source of errors in measurement seemed to be difficulties in recognition of the

reference points on the radiographs when viewed on the monitor, and therefore in defining

the line to be measured.

Sema Kedici P et al (2000) 25 obtained 20 measurements of different variables in incisor

teeth using a SEM micrometric scaler and the results were statistically correlated with age by

the multiple regression method. A formula was then derived from the calculations for age

estimation which gave statistically acceptable results. Gender differences were also

investigated and when separated delivered even stronger correlation.

Willems et al (2001)26 conducted a study was to evaluate the accuracy of Demirjian’s

dental age estimation in children in a Belgian Caucasian population and to adapt the scoring

system in case of a significant overestimation as frequently reported.2523

orthopantomograms of 1265 boys and 1258 girls, of which 2116 (1029 boys and 1087 girls)

were used for estimating the dental age with the Demirjian’s technique. The 407 other

orthopantomogram were beyond the original age limit. A second sample of 355

orthopantomograms was used to evaluate the accuracy of the original method and the

adapted method. A signed-rank test was performed to search for significant age differences


Page 11

between the obtained dental age and the chronological age. A weighted ANOVA was

performed in order to adapt the scoring system for this Belgian population. The

overestimation of the chronological age was confirmed. The adapted scoring system resulted

in new age scores expressed in years and in a higher accuracy compared to the original

method in Belgian Caucasians.

Martin-de las Heras et al (2002) 27 and coworkers, who have proposed the use of

spectroradiometry as an objective method for dentine color measurements for estimation of

age. Dentine color in 250 teeth from patients ranging in age from 10 to 89 years was

determined by spectroradiometry. Color measurements were performed as suggested in the

CIE 1931 (International Commission on Illumination). Chromaticity coordinates (x, y, z),

luminance (Y), whiteness index (WIC, Z%, WIC) and yellowness index (YI) were obtained.

Correlations between these colorimetric variables and aging were established by linear

regression analyses. All the variables fit the mathematical model with correlation coefficients

ranging from 0.53 to 0.75. This method of color measurement produced an expected

associated error of calibration averaging 13.7 years about the mean estimated values, at a

70% level of confidence. Two different multiple regression models for dental age estimation

were tested and variables that made the greatest contributions to age calculation were

identified.


Page 12

Tomoya Takasaki et al (2003) 28 conducted a study for the estimation of age based on

evidence found in teeth has received considerable attention within the field of forensic

science. They determined the terminal restriction fragment (TRF) length, as telomere length,

to estimate age. Using dental pulp DNA they found that the average TRF length showed a

tendency to shortening with aging. Their findings show that telomere shortening, based on

dental pulp DNA is a new and useful approach to estimate age of the subject at the time of

death.

Vandevoort F.M et al (2004) 29 correlated the dental age with an individual’s chronological

age based on the calculated volume ratio of pulp versus tooth volume measured. An X-ray

micro focus computed tomography unit (μCT) with 25μm spatial resolution was used to non-

destructively scan 43 extracted single root teeth of 25 individuals with well-known

chronological age. Custom-made analysis software was used by two examiners to obtain

numerical values for pulpal and tooth volume. The ratio of both was calculated and

statistically processed. No significant intra- or inter-examiner differences were found.

Wittwer-Backofen et al (2004) 30 conducted a study using tooth cementum annulations

(TCA) technique for estimating a subject’s age from cementum annulations. Indicators like

sex differences, intra individual correlations, and the effects of periodontal disease did not

have a quantitative effect on the number of TCA bands. A major disadvantage of the above

methods of estimating age in adults is the necessity to extract and/or section the teeth. While

this is possible in the dead, it is not practical among living adults.


Page 13

Paewinsky et al (2005) 31 analysed panoramic radiographs of 168 patients aged between 14

to 81 years. Pulp/root length, pulp/tooth length and pulp/root width at three different root

levels were calculated in one of mandibular lateral incisors, canines and first premolars and

maxillary central and lateral incisors and second premolars. The width ratios of the pulp

cavity showed significant correlation to the chronological age and the coefficient of

determination(r2) was highest in the upper lateral incisors

Nathalie Bosmans et al (2005) 32 applied Kvaal’s dental age calculation technique on one

hundred and ninety panoramic dental radiographs with the age group ranged from 19 to 75

years. There was no significant difference between long cone periapical technique and

orthopantomographs when all six teeth were selected to predict the age.

Roberto Cameriere et al (2006) 33 in a study to estimate the age from 33 skeletal remains by

using radiograph of canines. This method showed great reliability to estimate the age of old

subjects who died over 50 years.

Balwant Rai et al (2006)34 examined panoramic radiographs of 75 healthy children (40 boys

and 35 girls) aged between 5-14 years. Demirjian, Nolla, Haavikko, Williams and Cameriere

methods were applied for estimation of age. The result of our study have shown that

Williams method is more accurate followed by Haavikko, Cameriere, Nolla and lastly

Demirjian method.


Page 14

Kagerer et al (2000)35 suggested the possibility of age estimation from acellular cementum

incremental lines.This made use of mineralized, unstained cross-sections of teeth, preferably

mandibular central incisors and third molars. The authors claimed an accuracy of within two

to three years of the actual chronologic age. However, the pathologic state of the

periodontium and/or desmodontium may compromise the precision of ageing.

Sasidhar Singaraju et al (2009)36 conducted a retrospective study using two hundred

panoramic radiographs which were collected from V.S Dental College. Maximum tooth

length, root length and pulp length, root and pulp width at three levels were calculated on

right maxillary canine. The entire samples were divided into three groups and multiple

regression models were calculated. There was no significant difference between

chronological and estimated age. The observed correlation coefficients were 0.89,0.97 and

0.96.All three groups results were closely related to each other and it was found to be fairly

accurate.

Olze et al (2010) 37 determined determined the stages of third molar eruption in 347 female

and 258 male First Nations people of Canada aged 11 to 29 years based on radiological

evidence from 605 conventional orthopantomograms. The results presented here provide data

on the age of alveolar, gingival, and complete eruption of the third molars in the occlusal

plane that can be used for forensic estimation of the minimum and most probable ages of

investigated individuals.


Page 15

Medha Babshet et al (2010) 38 used Italian formula to estimate the age of Indian population

aged between 20-70years by using intraoral periapical digital radiographs of mandibular

canines which were taken by using paralleling technique. Mean absolute error was 11.58

years and 10.76 years for Italian and Indian formula respectively. No apparent difference was

observed between these two formulas.

Jayaraman et al (2011) 39 validated the applicability of Demirjian’s dataset on a southern

Chinese population. A total of 182 dental panoramic tomographs comprising an equal

number of boys and girls with an age range from 3 to 16 years were scored. Dental maturity

scores were obtained from the Demirjian’s dataset and dental age was calculated. The

difference in chronological and estimated dental ages was calculated using the paired t-test.

There was a mean overestimation of dental age of 0.62 years for boys (p<0.01) and 0.36

years for girls (p<0.01). He concluded that Demirjian’s dataset is not suitable for estimating

the age of 3-16 years old southern Chinese children.

Sudhanshu Saxena et al (2011) 40 developed a method for estimating the chronological age

of Indian adults based on morphologic variables of canine teeth from 120

orthopantomographs. Pulp/tooth area ratio, pulp/root length ratio, pulp/root width at the

cement-enamel junction level, pulp/root width ratio at mid root level, and pulp/root width

ratio at the midpoint between the cement-enamel junction and the mid root of the canine

were calculated. The estimated age in the total sample ranged from -2.2 to 1.5 years. No

significant difference was observed between chronological age and estimated age.


Page 16

Jagannathan et al (2011)41 evaluated the suitability of pulp/tooth volume ratio of

mandibular canines for age prediction in an Indian population using Volumetric

reconstruction of scanned images of mandibular canines of 140 individuals, age groups

ranging between 10 – 70 years. While using the Belgian formula for Indian population, the

mean absolute errors of 15.34 years, and 8.54 years error was obtained by regression

equation which was lower than those derived from former. Hence, they stated that specific

formula has to be applied to estimate the age of each population.

Jayanth Kumar et al (2011)42 evaluated the reliability of age estimation using Demirjian's

8 teeth method following the French maturity scores and India specific formula.The study

was conducted on 121 archived digital orthopantamographs which were predominantly pre-

treatment orthodontic radiographs from patients without any obvious developmental

anomalies The radiographs were evaluated as per Demirjian's criteria and age was calculated

using the formula developed for the Indian population.The results showed that the mean

absolute error for the study sample was 1.18 years; in 57.9% of cases the error rate was

within ±1 year. The age estimation using this method narrows down the error rate to just over

one year making this method reliable. However the inclusion of third molar increases the

error rates in the older individuals within the sample.

Chandramala et al (2012)43 concluded a study included 100 subjects of either sex between

age group of 20 and 80 years for assessment of age out of which 56 were males and 44 were

females. The mean age range of subjects in this group was 32.25 years for males and 29.08


Page 17

years for females. Correlation and regression analysis were carried out. From the results of

regression analysis, it was observed that the coefficient of determination R2 is highest

(0.385) for “Upper second premolar” indicating that age can be estimated better with this

particular tooth when “M” and “W-L” are considered as predictors of age. Both “M” and

“W-L” were found to be significant predictors.

Nithin Agarwal et al (2012)44 conducted a study to assess the chronological age based on

morphological variance of maxillary central incisors. Intra oral periapical radiographs were

taken using paralleling technique from fifty subjects aged between 20-70 years. Length of

tooth,pulp,root and width of root and pulp at three different points were measured.

Regression formulas were used to predict the age and it was found to be fairly accurate.

Bilge Nur et al (2012) 45 evaluated the applicability of Demirjian and Nolla methods for

northeastern Turkish population which was performed on panoramic radiographs of 673

subjects aged 5–15.9 years. The mean dental age (DA) according to the Demirjian and Nolla

methods were compared to the mean chronological age (CA). The mean CA of the study

sample was 10.37±2.90 and 10.03±2.81 years for females and males, respectively. Using the

Demirjian method, the mean estimated DA was 11.26±3.02 years for females and 10.87±2.96

years for males. For Nolla method, the mean estimated DA was 9.80±3.41 and 9.53±3.14

years for females and males, respectively. The mean differences between the CA and DA

according to the Demirjian and Nolla methods were 0.86 and -0.54 years for total study


Page 18

sample. Nolla method was found to be a more accurate method for estimating DA in

northeastern Turkish population.

Erbudak et al (2012) 46 examined the correlation between chronological and estimated ages

and evaluated the feasibility of length and width measurements of pulp cavity for age

estimation. The study population consisted of 123 patients with ages ranging from 14 to 57

years. The measurements of the length and width of six types of teeth on digitized panoramic

radiographs were performed, and the ratios between tooth and pulp cavity measurements

were calculated. Age was estimated using the linear regression models presented by Kvaal et

al. and Paewinsky et al. High differences were observed between chronological and

estimated ages. In conclusion, a difference of more than 12 years in the chronological and

estimated ages derived using regression models in literature was found on panoramic

radiographs in Turkish individuals.

Deepu George Mathew et al (2013)47 conducted a study to develop an independent method

to estimate the age of Indian individuals using mandibular posterior teeth in

orthopantomographs. Eighty eight subjects were included in the study and test subsets.

Adobe photoshop CS5 was used to measure the distance between central fossa to the highest

point on the root furcation and another point was the distance between the roof and floor of

the pulp chamber. The ratio derived between these two measurements was used to estimate

the age.R2 value was fairly good and this procedure was found to be fairly accurate to predict

the age.


Page 19

Djukic K et al (2013) 48 conducted a study that evaluated the accuracy of Demirjian's and

Willems' methods for dental age estimation in Serbian children population using panoramic

radiographs of 686 children (322 boys and 364 girls) with age range from 4 to 15 years. Both

methods showed discrepancy between obtained and chronological age. The Demirjian's

method overestimated age with a mean accuracy of 0.45 in boys and 0.42 in girls, while

Willems' method showed lower discrepancy (0.12 and 0.16 in boys and girls, respectively).

They suggested that Willem's method was more accurate for estimating dental age in

contemporary Serbian children population.

Sarkar S et al (2013) 49 evaluated age in children, adolescents and young adults using

Demirjian's 8-Teeth Method in an Indian population and compared the effectiveness of

existing Demirjian's formula with that of the Indian formula. Among the 100 samples the

mean chronological age in 50 males was 13.44 years and mean chronological age in 50

females was 13.12 years. It was evaluated that the Demirjian's formula underestimated the

mean dental age by 1.63 years in males and by 1.54 years in females, whereas a variation of

0.10 years in male and 0.94 years in female was found with the Indian formula. The mean

dental age obtained using Indian formula was approximating with the chronological age in

the male and female by a margin of 0.94 years. They concluded that Acharya's Indian

formula was more effective in evaluating the dental age closer to the chronological age of an

individual in an Indian population in comparison with the existing Demirjian's formula.

https://www.ncbi.nlm.nih.gov/pubmed/?term=Djukic%20K%5BAuthor%5D&cauthor=true&cauthor_uid=23835078

https://www.ncbi.nlm.nih.gov/pubmed/?term=Sarkar%20S%5BAuthor%5D&cauthor=true&cauthor_uid=23622465


Page 20

Ambarkova et al (2013)50 analyzed panoramic radiographs of 966 children (485 female and

481 male, aged 6–13 years) treated at the University and Community Dental Clinics in

Skopje using four Demirjian methods and a Willems method for determining dental ages.

Intra-rater and interrater agreement of mineralization stages were 0.86 and 0.82, respectively.

All methods significantly overestimated dental age when compared to the chronological age

(p < 0.001).

Limdiwala et al (2013)51 conducted a study using one hundred orthopantomographs with

Kvaal's criteria (Group A) and 50 orthopantomographs without Kvaal's criteria (Group B)

were included. On the basis of Kvaal's criteria, the difference between chronological age and

real age was 8.3 years. This suggests that the accuracy of this method depends on the

precision of measurements and quality and number of the orthopantomographs.

Mahkameh Moshfeghi et al (2014)52 conducted a study using 112 panoramic radiographs of

Iranian patients, to measure the amount of secondary dentin deposition o find out the age of

individuals. Patients aged between 20-70 years were included in the study. Then the

population was divided into two groups, study and test group respectively. Ratios of

pulp/root length, pulp/tooth length and pulp width /root width at three levels in lateral incisor,

canine and first premolar of mandible were calculated using Photoshop 2007.They conducted

that strong correlation coefficient was obtained in canine parameters to predict the age.


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Caroline Edward Ayad (2014)53 examined 99 Orthopantomgraphs (OPG) to determine its

usefulness of Orthopantomgraphs (OPGs) in the assessment of the Sudanese adult age

compared to chronological age. The pulp root length ,root length, pulp/root ratio , total tooth

length ,crown length of the mandibular canine were measured in mm and the estimated age

was recorded using the mandibular canine measurements .Patients were classified into three

groups ,A was of age <20 years old ,B was of 20 to 27 and C was of age >27. The estimated

age in A and C groups were well correlated with the chronological age in both genders and

no significant difference was detected, but in B group there is a significant difference

between the estimated and chronological age and between males and females measurements.

Mostafa M Afify et al (2014) 54 assessed the applicability of pulp tooth ratio of mandibular

canine, first and second premolars in orthopantomographs to estimate the age of an

individual. Total of 500 radiographs were included in the study, aged between 18 to 71 years.

Regression equation was closely correlated with age and standard errors of estimate was

ranged between 4.10 to 5.66 years. So, pulp-tooth ratio method was useful to estimate the age

of individuals.

Aída C. Medina et al (2014) 55 examined panoramic radiographs of 238 Venezuelan

children aged 5-13 years for assessment of dental age using the methods described by

Demirjian and Willem. For the Demirjian method, the mean difference between dental age

and chronological age was 0.62 ± 0.93 years, statistically significant. The mean

overestimation was lower for females than for males (females 0.56 ± 0.96 years, males 0.67

± 0.93 years). For the Willems method, the mean difference between dental age and


Page 22

chronological age was 0.15 ± 0.97 years, not statistically significant. Accuracy was

significantly different between genders, performing best for females (females 0.01± 0.96

years, males 0.29± 0.96 years). The Willems method for age estimation was found to be

more accurate than the Demirjian method in this sample of Venezuelan children.

Ioannis N.Tsatsoulis et al (2014)56 investigated the effects of age and external irritating

stimuli on the thickness and morphology of pulp chamber floor and ceiling in mandibular

molars. A total of 234 panoramic radiographs were obtained from School of Dentistry,

University of Athens. They calculated pulp chambers ceiling /crown height and pulp

chamber floor/crown height in relation to age and angle of pulp chamber ceiling and floor in

relation to age. There was significant difference in the location of secondary dentin formation

between the two pulp chamber walls. They concluded that increase in the rate of the pulp

chamber ceiling thickness is similar to that of the pulp chamber floor thickness. Age is

related to diminished pulp chamber size. They stated that the external stimuli also have an

effect on the pulp chamber dimensional changes.

Manjushree Juneja et al (2014) 57 conducted a study using panoramic radiographs to

estimate the age of 200 population with the age group of 18-72 years. Radiographic images

of maxillary canines (RIC) were processed using a computer –aided drafting program.

Following variables were recorded namely, pulp/root length, pulp/tooth length, pulp/root

width at enamel-cementum junction level, pulp/root width at mid-root level, pulp/root width

at mid-point level between CEJ level and mid-root level and pulp/tooth area ratio.Among


Page 23

these variables, the mid-root level and pulp/tooth area ratio showed strong correlation

coefficient and the estimated error was 3.012 years. They concluded that there was

significant correlation between age and morphological variables of canine.

Rezwana Begum Mohammed et al (2014)58 assessed the developmental stages of left

seven mandibular teeth for estimation of dental age (DA) in different age groups and to

evaluate the possible correlation between DA and chronological age (CA) in South Indian

population using Willems method. Digital Orthopantomogram of 332 subjects (166 males,

166 females) who fit the study and the criteria were obtained. Assessment of mandibular

teeth (from central incisor to the second molar on left quadrant) development was undertaken

and DA was assessed using Willems method. The present study showed a significant

correlation between DA and CA in both males (r = 0.71 and females (r = 0.88). The overall

mean difference between the estimated DA and CA for males was 0.69 ± 2.14 years (P <

0.001) while for females, it was 0.08 ± 1.34 years (P > 0.05). Willems method

underestimated the mean age of males by 0.69 years and females by 0.08 years and showed

that females mature earlier than males in selected population. The mean difference between

DA and CA according to Willems method was 0.39 years and is statistically significant (P <

0.05).This study showed significant relation between DA and CA.


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Jurca et al (2014) 59 conducted on X-rays of 285 children aged between 6-13 years. Dental

age was determined based on the degree of mineralisation of the seven left mandibular teeth,

and t-tests were used to assess the difference between dental age and chronological age

within each age category. Dental age was more advanced in girls in almost all age groups,

whereas in boys just the 6-7 and 8-9 age groups presented a more advanced dental age. The

results of the study showed that Demirjian’s method has some limitations for a Romanian

population, and that these standards are applicable only in certain age groups.

Patil et al (2014) 60 conducted a study which evaluating the accuracy of age estimation

formula of Kvaal and coauthors developed for Norwegian population. 100 subjects between

the age group 20 and 50 years digitized intraoral periapical (IOPA) radiograph of maxillary

central incisors was taken and length and width of the teeth were measured and their ratios

were calculated and applied to Kvaal and coauthors formula. The estimated age and

chronological age were compared, less accurate results were found in sample Indian

population. Modified Kvaal’s formula was then developed by using regression analysis of the

ratios and to evaluate the accuracy of this formula, the study was repeated using same criteria

and methodology on another subjects (101-200).Using Kvaal’s formula standard error of

estimated age was more in sample Indian population when compared with Norwegian

population. Then modified Kvaal’s formula was developed and applied to sample Indian

population, which showed accurate results. This study concluded that formula which was

derived from Norwegian population is not applicable to sample Indian population.


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Javadinejad et al (2015)61 conducted a study to compare the accuracy of four radiographic

age estimation methods. Orthopantomographic images of 537 healthy children (age: 3.9-14.5

years old) were evaluated. Dental age of the subjects was determined through Demirjian’s,

Willem’s, Cameriere’s, and Smith’s methods. The mean chronological age of the subjects

was 8.93 ± 2.04 years. Overestimations of age were observed follow-ing the use of

Demirjian’s method (0.87 ± 1.00 years), Willem’s method (0.36 ± 0.87 years), and Smith’s

method (0.06 ± 0.63 years). However, Cameriere’s method underestimated age by 0.19 ±

0.86 years. While paired t-tests revealed significant differences between the mean

chronological age and ages determined by Demirjian’s, Willem’s, and Cameriere’s methods

(P < 0.001), such a significant difference was absent between chronological age and dental

age based on Smith’s method (P = 0.079). Pearson’s correlation analysis suggested linear

correlations between chronological age and dental age determined by all four methods.

Kiran et al (2015)62 conducted a study to evaluate the applicability of Demirjian method and

its comparison with Indian formulas for estimation of dental age in subjects attending a

dental school in South India. A total of 250 individuals (130 males and 120 females) between

7 and 18 years, with orthopantamographs were included in the study. Dental age was

estimated using Demirjian’s and Indian formulas. The mean chronological age of the study

sample was 12.39 ± 3.32 years; while the mean age obtained from Demirjian’s method and

Indian‑specific regression formula were 11.56 ± 3.17 years and 14.20 ± 3.24 years,

respectively. In the present study, the Demirjian’s method under estimated dental age by 0.84


Page 26

years in males and 0.83 years in females (P < 0.05). Indian‑specific regression formulas

overestimated dental age by 1.72 years in males and 1.91 years in females (P < 0.05).

Ekta Priya et al (2015) 63 conducted a pilot study to test the applicability of Willem’s

method of dental age assessment at the threshold of 14 years considering prohibition of

employment of children. The sample consisted of 30 males and 30 females. The dental age

estimation was performed by two blinded examiners using Willem’s method. It was seen that

there was underestimation of age in both males and females. The difference in females and

males were -0.29 years and -0.23 years respectively. The scores of dental maturation

described by Willems may be suitable for South Indian children.

Gupta S et al (2015)64 assessed the applicability and compared the methods of dental age

estimation by Demirjian's method and the same method as modified by Willems in Indian

children of the National Capital Region (NCR).The study was conducted using dental

radiographs of 70 orthodontic patients (37 males, 33 females) in the age range 9-16 years

selected by simple random sampling. Orthopantomogram were used to estimate dental age by

Demirjian's method and the Willems method using their scoring tables. Lateral cephalograms

were used to estimate skeletal maturity using CVMI. The latter was compared with

Demirjian's stage for mandibular left second molar.and concluded that Willems method have

proved to be more accurate for age estimation among Indian males, and Demirjian's method

for Indian females. A statistically significant association appeared between Demirjian's

stages and CVMI among both males and females.


Page 27

Lee SS et al (2011) 65 evaluated validity of Demirjian's and the modified methods in Korean

juveniles and adolescents using 1483 digital orthopantomograms which consist of 754 males

and 729 females in the age range of 3-16 years were collected. New age estimation method

based on Korean population data was calculated. Willems' method was found to be most

accurate followed by new Korean method with slight difference for Korean population for

both sexes and concluded that both Willems' method and new Korean method conducted by

present study were proven to be suitable for Korean population.

Uday Ginjupally et al (2015)66 designed a study to estimate the age of 200 intra oral

periapical radiographs of maxillary incisors. Pulp cavity width is measured at cervical and

middle third of maxillary incisors using digital Vernier caliper. Regression formulas were

derived for males and 0.21 years in females. Hence, there was difference between male and

female regarding age prediction.

El Morsi DA et al (2015)67 conducted a study to estimate the age from tooth coronal index

of mandibular premolars and molars of both sides using panoramic radiographs of known

age. Study included 234 Egyptian subjects of known age. The length of tooth crown and that

of coronal pulp cavity were measured in 845 mandibular premolars and 835 mandibular

molars.TCI for premolars was larger than those of molars and it was higher in males than

females. It was concluded that there was highest significant correlation of the second right

premolar TCI with age.

https://www.ncbi.nlm.nih.gov/pubmed/?term=Lee%20SS%5BAuthor%5D&cauthor=true&cauthor_uid=21561728


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Indira AP et al (2015)68 conducted a study using 100 intra oral periapical radiographs of

both genders aged between 16 and 50 years. The tooth selected for the study was left

maxillary central incisor. The ratio between total pulp length and cervical pulp width was

calculated. There was negative correlation between the age and the variable. Hence, this

study estimated the nearest chronological age of an individual.

Ranjdar M.Talabani et al(2015)69 analysed permanent mandibular first molar on digital

panoramic radiographs of sulaimani population. This study included 96 individuals who were

divided into four groups. The height of coronal pulp cavity and the height of crown of first

molars from all subjects were measured and a regression equation was calculated. There was

a strong negative linear relationship between morphology of mandibular first molars with

chronological age. So, they concluded that study showed a good degree of accuracy in

predicting age.

Smrithi D Veera et al (2015)70 conducted a study using 100panoramic radiographs and the

subjects aged between 20-60 years. Mandibular permanent second premolar and first molar

tooth coronal index was measured. Regression equation was created. There was no difference

between estimated and chronological age for both second premolar and molar configurations.


Page 29

Nerella Narendra Kumar et al (2016)71 estimated the age of Davangere population by

measuring the pulp tooth area ratio using digitized intaoral periapical radiographs of

permanent mandibular second molar. Study subjects aged between 14-60 years of both

genders. The standard error of estimate was 12 years which wasn’t in the acceptable range.


Page 31

SOURCE OF DATA

The present study was conducted in K.S.R Institute of Dental Science and Research,

Tiruchengode. Those who referred to the oral medicine and radiology department for the

purpose to undergo orthodontic treatment, will be selected randomly for the study were taken

up for the study. Orthopantmographs taken for orthodontic treatment purpose were retrived

from the data and One Intra oral periapical radiograph were taken for the same patient for

this study purpose.

INCLUSION CRITERIA

Above the age of 8 years

Only fully erupted mandibular first molar in normal functional occlusion

Those who give voluntary consent for the study procedure

Absence of systemic diseases, dental anomalies, nutritional and endocrine problems,

premature birth, and birth defect

EXCLUSION CRITERIA

Teeth with radio-opaque fillings

Crowns/prosthesis

Any associated pathologies

Malalignment, rotation

Impacted teeth


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Teeth with developmental anomalies

Attrited teeth

MATERIALS USED:

WILLEMS METHOD:

Digital Panoramic System:SIRONA-ORTHOPHOS XG

Computer : Acer 15.6”HD LED LCD

Image Editing Software ; Adobe Photoshop CS-6

KVAAL’S METHOD:

Dental Radiograph Machine : Confident Dental Equipments

Dental Intra Oral Xray film : Carestream Dental E-speed size 2

Fim holder : Dentsply Rinn holder

Automated processor unit : Velprex Extra-X

Dryer

Tracing sheet

Apsara plantinum pencil

Magnifying glass

Divider

Measuring scale


Page 33

METHODOLOGY

Patients who referred to the oral medicine and radiology department for the purpose

to undergo orthodontic treatment were selected randomly for the study. Informed consent

was obtained prior to the investigatory procedure. Orthopantmographs was taken for

orthodontic treatment purpose and One Intra oral periapical radiograph in relation to right

mandibular first molar by using paralleling cone technique were taken for the same patient

for this study purpose. The study sample consisted of 75 randomly selected subjects ( males

and females) of age ranging from 8 to years divided into five groups according to age.

Clinical examination of all 75 individuals was performed and name, sex, and date of birth of

each individual and date of radiography were recorded. CA of an individual was calculated

by subtracting the birth date from the date on which the radiographs were exposed for that

particular individual. The dental age was determined using orthopantamographs by Willem’s

method and using Intra oral periapical radiograph by Kvaal’s method.

Willem’s method :

The panoramic images were obtained in the Digital Imaging and Communication in

Medicine (DICOM) format, were saved as DICOM files on a computer and were analysed by

using the Adobe Photoshop CS6 image editing program. With the help of Photoshop

generator, the images were enlarged and adjusted with the brightness/contrast, if needed. The

obtained panoramic images were used to assess the status of maturation on the basis of

calcification of the permanent teeth in mandibular right side, from central incisor to the

second molar, using Demirjian et al., method(Table 1).After noting all stages of teeth from

central incisor to the second molar, the developmental status of a particular tooth was


Page 34

calculated in years on the basis of tables given by Willems et al,.(Table 2). All the values

from central incisor to the second molar thus obtained were summed to obtain an overall

maturity score, which will indicate the DA of that particular patient.

Kvaal’s method :

Intra-oral periapical radiographs of right mandibular first molar were taken by using

paralleling cone technique. The exposed films were developed in automatic processor in

fresh solutions. The developed X-ray films were dried and subsequently coded. Intra oral

periapical radiographs are traced on tracing sheet. On the radiographs obtained, 15

standardized points were marked, on the basis of the original method for dental age

calculation published by Kvaal et al., and measurements were taken using divider and scale

with millimeter calibrations.

• Tooth length (T)

• Pulp length (P)

• Root length (R)

• Ratio of Pulp width to Root width

• A: Cemento-Enamel Junction

• B: Midpoint between A and C

• C: Midroot level

The ratios calculated were:

P - Pulp length/root length

R - Pulp length/tooth length.

Ratios of the pulp/root width at three different levels:

At the ECJ (A)


Page 35

At the midpoint between ECJ and mid root level (B)

At the mid root level (C)

The obtained values were applied to the formula developed to estimate the age from right

mandibular first molar given by Kvaal and coauthors.

Age = 33.5 – 18.6 (M) – 3.49 (W − L)

M = 𝑃+𝑅+𝐴+𝐵+𝐶

5

W =𝐵+𝐶

2

L= 𝑃+𝑅

2

W = Mean value of width ratios from level B and C

L = Mean value of length ratios P and R

W − L = Differences between W and L

The estimated age was compared with the chronological age recorded and the efficacy of the

formula in estimating the age was evaluated.


Page 36

Table I :Description for developmental stages of tooth

STAGES

DESCRIPTION

A A begining of calcification is seen at the superior level of crypt in the form

of cones. There is no fusion of these calcified points.

B Fusion of the calcified points forms one or more cusps, giving a regularly

outlined occlusal surface

C Enamel and dentin formation is complete at the occlusal surface and

converge at cervical region. Dentin deposition is seen. The outline of the

pulp chamber has a curved shaped at the occlusal border.

D Crown formation is completed down to the cementoenamel junction.

Superior border of pulp chamber in uniradicular teeth has a definite curved

form; projection of pulp horns gives an umbrella top. In molars, pulp

chamber has a trapezoidal form. Begining of root formation is seen in the

form of a spicule

E

Uniradicular teeth

The walls of pulp chamber form straight lines, whose continuity is broken

by the pulp horn. The root length is less than the crown height.

In Molars

Initiation of radicular bifurcation is seen as a calcified point or a semi-lunar

shape. Root length is less than crown height.


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F Uniradicular teeth

The walls of pulp chamber form isosceles triangle. Apex ends in a funnel

shaped. The root length is equal to or greater than the crown height.

In molars

The bifurcation has developed down to give the roots a distant outline with

funnel shaped endings. Root length is equal to or greater than crown

height.

G The walls of root canal are now parallel and its apical end is partially

open(distal root in molars)

H The apical end of the root canal is completely closed. Periodontal

membrane has a uniform width around the root and apex.


Page 38

Table 2 : Developmental status of a particular tooth by Willems et al.,

GENDER TOOTH A B C D E F G H

Boys Central

Incisor

- - 1.68 1.49 1.5 1.86 2.07 2.19

Lateral Incisor - - 0.55 0.63 0.74 1.08 1.32 1.64

Canine - - - 0.04 0.31 0.47 1.09 1.9

First Bicuspid 0.15 0.56 0.75 1.11 1.48 2.03 2.43 2.83

Second

Bicuspid

0.08 0.05 0.12 0.27 0.33 0.45 0.4 1.15

First Molar - - - 0.69 1.14 1.6 1.95 2.15

Second Molar 0.18 0.48 0.71 0.8 1.31 2 2.48 4.17

Girls Central

Incisor

- - 1.83 2.19 2.34 2.82 3.19 3.14

Lateral Incisor - - - 0.29 0.32 0.49 0.79 0.7

Canine - - 0.6 0.54 0.62 1.08 1.72 2

First Bicuspid -0.95 -0.15 0.16 0.41 0.6 1.27 1.58 2.19

Second

Bicuspid

-0.19 0.01 0.27 0.17 0.35 0.35 0.55 1.51

First Molar - - - 0.62 0.9 1.56 1.82 2.21

Second Molar 0.14 0.11 0.21 0.32 0.66 1.28 2.09 4.04


Page 39

Figure 1-Digital Panoramic System : SIRONA-ORTHOPHOS X G


Page 40

Figure 2 – Dental Radiograph Machine – Carestream Dental


Page 41

Figure 3 – Dental Intra Oral Xray Film

Figure 4 – Dentsply Rinn Holder


Page 42

Figure 5 – Automatic Processor

Figure 6 Armamentarium for Tracing Radiograph


Page 43

Figure 7-Tooth Length

Figure 8 – Pulp Length


Page 44

Figure 9 – Root Length

Figure 10 – Width of the Pulp At Cemento-enamel Junction


Page 45


The data obtained from the study was entered in Microsoft Excel and was given

for statistical analysis. The data was analysed using Statistical Package for Social

Sciences(SPSS) software version 16.0(Windows version 17.0 SPSS

Inc.,Chicago,IL,USA).The level of significance (α) was fixed at 5% (p≤0.05).

PAIRED t TEST :

Student’s t test was used to analyze the significance between the two different age

estimation methods. Paired t test is applied when there is a pair of data from single element in

an observation .Data are collected by two different methods for a same person, so that the

same group participated in both the methods. Then the mean of both the groups are compared

to get the t value.

RESULTS

RESULTS

Page 47

Descriptive analysis

The study comprises of 24 males and 51 females of age ranging from 7-32 years. The

subjects were divided into five groups ,where 7 males and 8 females of age ranging from 27-

32 years were in group I, 7 males and 8 females of age ranging from 22-26 years were in

group II, 5 males and 10 females of age ranging from 17-21 years were in group III, 2 males

and 13 females of age ranging from 12-16 years were in group IV ,3 males and 12 females of

age ranging from 7-11 years were in group V. Each group comprises of 15 subjects.

RESULTS

Page 48

Table III : Distribution of the subjects by their age and gender

Group Age ranges Male Female Total

No. % No. %

I 27-32 years 7 47 8 53 15

II 22-26 years 7 47 8 53 15

III 17-21 years 5 33 10 66.7 15

IV 12-16 years 2 13 13 86.7 15

V 7-11 years 3 20 12 80 15

RESULTS

Page 49

Table IV : ILLUSTRATING THE RESULTS OBTAINED FROM KVAAL’S METHOD

(GROUP 1)

S.No GENDER CA P R M W L KVAAL

METHOD

DA

1 Female 27 1.22 0.74 0.73 0.7 1.64 16.6

2 Male 30 1.05 0.73 0.71 0.6 0.89 19.1

3 Female 28 1.17 0.81 0.76 0.7 1.02 18.2

4 Male 28 1.23 0.81 0.76 0.7 1.02 18.2

5 Male 29 1.05 0.78 0.70 0.6 0.91 19.32

6 Female 29 1.15 0.76 0.62 0.45 0.95 20.22

7 Male 29 1.11 0.82 0.69 0.5 0.96 19.2

8 Female 29 1.12 0.76 0.71 0.5 0.97 18.9

9 Female 27 1.17 0.76 0.74 0.6 0.97 18.46

10 Female 31 1.07 0.73 0.74 0.7 0.9 19.04

11 Female 27 1.05 0.73 0.72 0.6 0.89 19.17

12 Male 28 1.23 0.81 0.76 0.7 1.02 18.2

13 Female 26 1.12 0.76 0.71 0.5 0.97 18.9

14 Male 27 1.05 0.78 0.70 0.6 0.9 19.32

15 Male 29 1.05 0.73 0.71 0.6 0.8 19.17

P - Pulp length/root length; R - Pulp length/tooth length; M – mean value of all length and

width; W - Mean value of width ratios from level B and C;L -Mean value of length ratios P

and R

RESULTS

Page 50

Table V: ILLUSTRATING THE RESULTS OBTAINED FROM KVAAL’S METHOD

(GROUP 2)

S.No GENDER CA P/L R/L M W L KVAAL

METHOD

DA

1 Female 20 1.4 0.76 0.77 0.6 1.08 20.85

2 Female 20 1.13 0.68 1.45 0.4 1.95 11.08

3 Female 20 1.14 0.64 1.32 0.55 1.9 13.71

4 Female 20 1.07 0.65 0.64 0.5 0.86 22.9

5 Male 20 1.12 0.69 0.7 0.61 0.91 21.5

6 Female 19 0.88 0.66 0.6 0.55 0.77 22.7

7 Female 21 1.21 0.63 0.71 0.65 0.92 21.24

8 Female 23 1.15 0.75 0.73 0.61 0.95 21.11

9 Male 21 1.13 0.77 0.69 0.55 0.95 22.09

10 Male 22 1.18 0.8 0.7 0.5 0.99 22.2

11 Male 22 1.14 0.77 0.7 0.77 0.95 18.37

12 Male 22 1.28 0.09 0.63 0.7 0.69 21.79

13 Male 22 1.14 0.8 0.66 0.5 0.97 19.6

14 Female 22 1.16 0.82 0.72 0.5 0.99 18.47

15 Male 21 1.16 0.77 0.71 0.6 0.97 19.09



and R

RESULTS

Page 51

Table VI : ILLUSTRATING THE RESULTS OBTAINED FROM KVAAL’S METHOD

(GROUP 3)


METHOD

DA

1 Male 18 1.125 0.66 0.75 0.68 0.9 20.31

2 Female 18 1.14 0.63 0.66 0.62 0.88 22

3 Female 20 1.13 0.652 0.68 0.62 0.9 21.63

4 Male 20 1.14 0.8 0.66 0.5 0.97 19.6

5 Female 19 1.13 0.68 0.7 0.6 0.91 21.52

6 Female 20 1.15 0.75 0.56 0.35 0.95 25.17

7 Female 20 1.13 0.77 1.22 0.6 1.65 14.47

8 Female 21 1.125 0.66 0.75 0.68 0.9 20.31

9 Female 21 1.23 0.89 0.78 0.65 1.06 17.5

10 Female 21 1.33 0.8 0.84 0.75 1.06 16.79

11 Male 19 1.26 0.78 0.71 0.5 1.02 18.5

12 Female 17 1.23 0.89 0.78 0.65 1.06 17.5

13 Female 18 1.24 0.66 0.8 0.75 0.95 17.92

14 Male 17 1.09 0.75 0.72 0.65 0.92 19.16

15 Male 16 0.11 0.09 0.32 0.5 0.1 26.15



and R

RESULTS

Page 52

Table VII: ILLUSTRATING THE RESULTS OBTAINED FROM KVAAL’S METHOD

(GROUP 4)


METHOD

DA

1 Female 14 1.23 0.76 1.34 0.65 1 9.82

2 Female 14 1.06 0.65 1.48 0.7 1.95 10.36

3 Female 15 1.14 0.63 0.77 0.74 0.8 9.76

4 Female 14 1.07 0.74 0.74 0.65 0.9 18.86

5 Female 13 1.07 0.74 0.74 0.65 0.9 18.86

6 Male 16 0.63 0.44 0.57 0.65 0.53 22.48

7 Female 13 1.07 0.74 0.74 0.65 0.9 18.86

8 Female 16 1.21 0.77 0.7 0.6 0.99 19.6

9 Female 16 1.13 0.82 0.69 0.5 0.98 18.9

10 Female 14 1.18 0.75 0.76 0.7 0.97 18.42

11 Female 16 1.21 0.77 0.7 0.6 0.99 19.6

12 Female 16 1.13 0.82 0.69 0.5 0.98 18.9

13 Female 13 1.07 0.74 0.74 0.65 0.9 18.86

14 Male 18 0.63 0.44 0.57 0.65 0.53 22.48

15 Female 15 1.21 0.77 0.7 0.6 0.99 19.6



and R

RESULTS

Page 53

Table VIII: ILLUSTRATING THE RESULTS OBTAINED FROM KVAAL’S METHOD

(GROUP 5)


METHOD

DA

1 Female 8 1.21 0.85 0.87 0.8 1.03 16.51

2 Male 8 1.22 0.78 0.86 0.85 1 16.98

3 Female 8 1.12 0.7 0.7 0.5 0.9 19.04

4 Female 10 1.09 1.09 0.8 0.6 1.09 16.9

5 Female 10 1.11 0.73 0.76 0.7 0.9 18.59

6 Female 10 1.28 0.86

0.8 -.75 1.07 17.5

7 Female 9 1.18 0.78 0.73 0.6 098 18.56

8 Female 8 1.13 0.78 0.88 0.8 0.95 16.6

9 Female 9 1.08 0.77 0.73 0.6 0.92 18.9

10 Male 9 1.12 0.75 0.81 0.7 0.93 17.63

11 Female 9 1.03 0.68 0.7 0.6 0.85 19.78

12 Female 10 1.09 0.81 0.74 0.5 0.95 5.97

13 Female 11 1.15 0.73 0.77 0.7 0.94 18.9

14 Female 10 1.14 0.87 0.8 0.75 1.01 17.74

15 Male 10 1.16 0.86 0.84 0.7 1.01 16.79



and R

RESULTS

Page 54

TABLE IX: DEVELOPMENTAL STAGES OF EACH OF THE RIGHT MANDIBULAR

TEETH FOR GROUP I

S.No. GENDE

R

CA 41 42 43 44 45 46 47

1 Female 27 H H H H H H H

2 Male 30 H H H H H H H














RESULTS

Page 55

TABLE X: DEVELOPMENTAL STAGES OF EACH OF THE RIGHT MANDIBULAR

TEETH FOR GROUP II

S.No. GENDE

R

CA 41 42 43 44 45 46 47


2 Female 20 H H F H G H F

3 Female 20 H H H H G G H

4 Female 20 H H H H G H F

5 Male 20 H H G G F H G

6 Female 19 H H G H H H G


8 Female 23 H H G F G H G








RESULTS

Page 56

TABLE XI: DEVELOPMENTAL STAGES OF EACH OF THE RIGHT MANDIBULAR

TEETH FOR GROUP III

S.No. GENDE

R

CA 41 42 43 44 45 46 47

1 Female 14 H H G F F H E

2 Female 14 H H G G G H G

3 Female 15 H H G E F H F



6 Male 16 H H H H G H G


8 Female 16 H H F H G H E

9 Female 16 H H G H G H H



12 Female 16 H H G H G H H


14 Male 16 H H H H G H G


RESULTS

Page 57

TABLE XII: DEVELOPMENTAL STAGES OF EACH OF THE RIGHT MANDIBULAR

TEETH FOR GROUP IV

S.No. GENDE

R

CA 41 42 43 44 45 46 47

1 Female 14 H H G F F H E

2 Female 14 H H G G G H F

3 Female 15 H H G E F H F

4 Female 14 H H G F G H F

5 Female 13 H H G G F H F

6 Male 16 H H G H G H G

7 Female 13 H H G G F H G

8 Female 16 H H F H F H G

9 Female 16 H H G H F H H

10 Female 14 H H G G F H G


12 Female 16 H H G H F H H

13 Female 13 H H F F F H F

14 Male 16 H H G H G H G


RESULTS

Page 58

TABLE XIII: DEVELOPMENTAL STAGES OF EACH OF THE RIGHT MANDIBULAR

TEETH FOR GROUP V

S.No. GENDE

R

CA 41 42 43 44 45 46 47

1 Female 8 F G E D D F B

2 Male 8 F F E D D H D

3 Female 8 G F D D D G C

4 Female 10 G F F E F H C

5 Female 10 G G E D D F B

6 Female 10 F E E D D G D

7 Female 9 E E E E D G B

8 Female 8 F F E D D G C

9 Female 9 G G E D D G C

10 Male 10 G G D D D G C

11 Male 9 G G D D D G C

12 Female 9 G G E F F H E

13 Female 11 H H E F F G G

14 Female 10 E H E E F G G

15 Male 10 E H E F F F G

RESULTS

Page 59

Table XIV: ILLUSTRATING THE RESULTS OBTAINED FROM WILLEM’S METHOD

(GROUP 1)

S.No. GENDE

R

CA 41 42 43 44 45 46 47 Wille

ms

metho

d

1 Female 27 3.14 0.7 2 2.19 1.51 2.21 4.04 15.79

2 Male 30 2.19 1.64 1.9 2.83 1.15 2.15 4.17 16.03

3 Female 28 3.14 0.7 2 2.19 1.51 2.21 4.04 15.79

4 Male 28 2.19 1.64 1.9 2.83 1.15 2.15 4.17 16.03

5 Male 29 2.19 1.64 1.9 2.83 1.15 2.15 4.17 16.03

6 Female 29 3.14 0.7 2 2.19 1.51 2.21 4.04 15.79

7 Male 29 2.19 1.64 1.9 2.83 1.15 2.15 4.17 16.03

8 Female 29 3.14 0.7 2 2.19 1.51 2.21 4.04 15.79

9 Female 27 3.14 0.7 2 2.19 1.51 2.21 4.04 15.79

10 Female 31 3.14 0.7 2 2.19 1.51 2.21 4.04 15.79

11 Female 27 3.14 0.7 2 2.19 1.51 2.21 4.04 15.79

12 Male 28 2.19 1.64 1.9 2.83 1.15 2.15 4.17 16.03

13 Female 26 3.14 0.7 2 2.19 1.51 2.21 4.04 15.79

14 Male 27 2.19 1.64 1.9 2.83 1.15 2.15 4.17 16.03

15 Male 29 2.19 1.64 1.9 2.83 1.15 2.15 4.17 16.03

RESULTS

Page 60

Table XV: ILLUSTRATING THE RESULTS OBTAINED FROM WILLEM’S METHOD

(GROUP 2)

S.No. GENDE

R

CA 41 42 43 44 45 46 47 Wille

ms

metho

d

1 Female 20 3.14 0.7 2 2.19 1.51 2.21 4.04 15.79

2 Female 20 3.14 0.7 1.08 2.19 0.55 2.21 1.28 11.15

3 Female 20 3.14 0.79 2 2.19 0.55 1.82 4.04 14.53

4 Female 20 3.14 0.7 2 2.19 0.55 2.21 1.28 12.07

5 Male 20 3.14 0.7 1.72 1.58 0.35 2.21 2.09 11.79

6 Female 19 3.14 0.7 1.72 2.19 1.51 2.21 2.09 13.56

7 Female 21 3.14 0.7 2 2.19 1.51 2.21 4.04 15.79

8 Female 23 3.14 0.7 0.49 2 0.55 2.21 1.28 10.37

9 Male 21 2.19 1.64 1.9 2.83 1.15 2.15 4.17 35.74

10 Male 22 2.19 1.64 1.9 2.83 1.15 2.15 4.17 16.03

11 Female 21 3.14 0.7 2 2.19 1.51 2.21 4.04 15.79

12 Female 22 3.14 0.7 2 2.19 1.51 2.21 4.04 15.79

13 Male 22 2.19 1.64 1.9 2.83 1.15 2.15 4.17

16.03

14 Female 22 3.14 0.7 2 2.19 1.51 2.21 4.04 15.79

15 Male 22 2.19 1.64 1.9 2.83 1.15 2.15 4.17 16.03

RESULTS

Page 61

Table XVI: ILLUSTRATING THE RESULTS OBTAINED FROM WILLEM’S METHOD

(GROUP 3)

S.No. GENDE

R

CA 41 42 43 44 45 46 47 Wille

ms

metho

d

1 Male 18 2.19 1.64 1.9 2.83 1.15 2.15 2.48 14.34

2 Female 18 3.14 0.7 1.72 2.19 0.55 2.21 2.09 12.67

3 Male 20 3.14 0.7 1.72 2.19 1.51 2.21 1.28 12.75

4 Male 20 2.19 1.64 1.9 2.43 1.15 2.15 2.48 13.94

5 Female 19 3.14 0.7 2 1.58 1.51 2.21 4.04 15.18

6 Female 20 3.14 0.7 1.72 2.19 0.55 2.21 2.09 12.6

7 Female 20 3.14 0.7 2 2.19 0.55 2.21 2.09 12.88

8 Female 18 3.14 0.7 1.72 2.19 0.55 2.21 2.09 12.67

9 Female 21 3.14 0.7 1.72 2 1.15 2.21 1.28 12.2

10 Female 21 3.14 0.7 1.08 2.19 0.55 2.21 2.09 11.27

11 Male 19 2.19 1.64 1.09 2.83 0.4 2.15 4.17 14.47

12 Female 17 3.14 0.7 1.72 2.19 0.55 2.21 4.04 13.56

13 Female 18 3.14 0.7 2 2.19 1.51 2.21 2.09 13.84

14 Female 17 3.14 0.7 2 2.19 1.51 2.21 4.04 15.77

15 Male 16 2.19 1.64 1.9 2.83 1.15 2.15 4.17 16.03

RESULTS

Page 62

Table XVII: ILLUSTRATING THE RESULTS OBTAINED FROM WILLEM’S METHOD

(GROUP 4)

S.No. GENDE

R

CA 41 42 43 44 45 46 47 Wille

ms

metho

d

1 Female 14 3.14 0.7 1.72 1.27 0.35 2.21 0.66 10.05

2 Female 14 3.14 0.7 1.72 1.58 0.5 1.51 1.82 11.23

3 Female 15 3.19 0.79 1.72 0.6 0.35 2.21 1.28 10.14

4 Female 14 3.14 0.7 0.49 2 0.55 2.21 1.28 10.37

5 Female 13 3.14 0.7 1.72 1.58 0.55 2.21 1.82 11.72

6 Male 16 2.19 1.64 1.9 2.83 0.4 2.15 2.48 13.59

7 Female 13 3.19 0.79 1.72 1.58 0.55 2.21 2.09 10.93

8 Female 16 3.14 0.7 1.08 2.19 0.55 2.21 0.09 12.16

9 Female 16 3.14 0.7 1.72 2.19 0.55 2.21 4.04 14.55

10 Female 14 3.19 0.79 1.72 1.58 0.55 2.21 2.09 12.43

11 Female 16 3.14 0.7 1.08 2.19 0.55 2.21 0.09 12.16

12 Female 16 3.14 0.7 1.72 2.19 0.55 2.21 4.04 14.55

13 Female 13 3.14 0.7 0.49 2 0.55 2.21 1.28 10.37

14 Male 16 2.19 1.64 1.9 2.83 0.4 2.15 2.48 13.59

15 Female 16 3.14 0.7 1.08 2.19 0.55 2.21 0.09 12.16

RESULTS

Page 63

Table XVIII: ILLUSTRATING THE RESULTS OBTAINED FROM WILLEM’S

METHOD (GROUP 5)

S.No. GENDE

R

CA 41 42 43 44 45 46 47 Wille

ms

metho

d

1 Female 8 2.82 0.79 0.62 0.41 0.27 1.56 0.11 6.58

2 Male 8 1.86 1.08 0.31 1.11 0.27 2.15 0.8 7.58

3 Female 8 3.19 0.49 0.54 0.41 0.27 0.62 0.21 7.43

4 Female 10 3.19 0.49 1.08 0.6 0.35 2.21 0.32 8.24

5 Female 10 3.19 0.79 0.62 0.41 0.27 1.56 0.11 6.95

6 Female 10 2.82 2.49 0.62 0.41 0.27 1.82 0.32 6.75

7 Female 9 2.34 0.32 0.62 0.16 0.27 1.82 0.11 5.64

8 Female 8 2.82 0.49 0.62 0.41 0.17 1.82 0.21 5.34

9 Female 9 3.14 0.79 0.62 0.41 0.17 1.82 0.21 7.16

10 Male 10 2.07 1.32 0.04 1.11 0.27 1.95 0.71 7.47

11 Male 9 2.07 1.32 0.04 1.11 0.27 1.95 0.71 7.47

12 Female 9 3.19 0.79 0.62 1.27 0.36 2.21 0.66 9.09

13 Female 11 2.19 0.7 0.62 1.27 0.35 1.82 2.09

9.04

14 Female 10 2.34 0.7 0.62 0.6 0.35 1.82 2.09 8.52

15 Male 10 1.5 1.64 0.31 2.03 0.45 1.6 2.48 10.08

RESULTS

Page 64

Table XIX : Mean and SD of different age estimation methods of different age groups

Age groups

Age in

years

CA Willem’s method Kvaal’method

Mean SD Mean SD Mean SD

I

27-32 years 28.26 1.33 15.9 0.12 18.88 0.80

II

22-26 years 21.0 1.13 15.49 5.95 19.78 3.36

III

17-21 years 19.00 1.60 13.75 1.31 19.90 3.09

IV 12-16 years 14.86 1.45 11.85 1.65 17.69

4.17

V

7-11 years 9.26 0.96 7.55 1.28 17.09 3.24

Total 7-27 years 18.48 6.50 12.91 4.15 18.67 3.26

This shows the mean and standard deviation of chronological age and dental age by Willems

method and Kvaal’s method for age groups.

RESULTS

Page 65

Table XX : Descriptive statistics of two age estimation methods

Age groups

Age in

years


Minimum Maximum Minimum Maximum Minimum Maximum

I

27-32

years

26 31 15.79 16 16.60 20.22

II

22-26

years

19 23 10.37 35.74 11.08 22.90

III

17-21

years

16 21 11.27 16.03 14.47 26.15

IV 12-16

years

13 18 9.41 14.55 9.76 22.48

V

7-11 years 8 11 5.34 10.08 5.97 19.78

RESULTS

Page 66

Table XXI : Confidence Interval for different age estimation methods

Group

Age in

years

CA

(95% CI)

Willem’s method

(95% CI)

Kvaal’s method

(95% CI)

Upper

bound

Lower

bound

Upper

bound

Lower

bound

Upper

bound

Lower

bound

I

27-32 27.52 29.00 15.83 15.83 18.43 19.33

II

22-26 20.37 21.19 12.19 12.19 17.91 21.64

III

17-21 18.11 19.88 13.02 13.02 18.18 21.61

IV 12-16

14.05 15.67 10.94 10.94 15.37 20

V

7-11 8.73 9.79 6.84 6.84 15.29 18.88

RESULTS

Page 67

Table XXII : Mean age of different age estimation methods by gender

Gender N Mean Std. Deviation Std. Error Mean

CA

Male 24 20.8750 6.37463 1.30122

Female 51 17.3529 6.30816 .88332

Willem Male 24 15.1017 5.11721 1.04455

Female 51 11.8829 3.17280 .44428

Kvaal

Male 24 19.8875 2.14479 .43780

Female 51 18.0972 3.54679 .49665

Table XXI : Levene’s Test and t-test for Equality of Variances

Levene’s Test for Equality of

Variances

t-test for Equality of Variances

F Sig. t df

CA

Willem

Kvaal

.141

.000

1.685

.708

.992

.198

2.248

3.341

2.280

73

73

73

RESULTS

Page 68

Table XXII : Mean differences and Standard error differences of different age estimation

methods

t-test for Equality of Means

Sig. (2-tailed) Mean

Difference

Std. Error

Difference

95%

Confidence

Interval of the

Difference

Lower

CA

Equal variances assumed .028 3.52206 1.56671 .39962

Equal variances not

assumed .030 3.52206 1.57271 .35390

Willem

Equal variances assumed .001 3.21873 .96334 1.29879

Equal variances not

assumed .008 3.21873 1.13510 .90544

Kvaal

Equal variances assumed .026 1.79028 .78534 .22510

Equal variances not

assumed .009 1.79028 .66207 .46925

RESULTS

Page 69

Chart 1 : Distribution of the subjects by their age and gender

Chart 2 : Mean chronological age of different age groups

0%

20%

40%

60%

80%

100%

120%

Group I Group II Group III Group IV Group V

Female

Male

0

5

10

15

20

25

30

27-32 yrs 22-26yrs 17-21yrs 12-16yrs 7-11yrs

CA

RESULTS

Page 70

Chart 3 : Mean estimated dental age of different age groups by Willem’s

method

Chart 4 : Mean estimated dental age of different age groups by Kvaal’s

method

0

2

4

6

8

10

12

14

16

18


Willem's method

15.5

16

16.5

17

17.5

18

18.5

19

19.5

20

20.5


Kvaal's method

RESULTS

Page 71

Chart 5 : Mean estimated dental age of different age groups by different

age estimation methods

0

10

20

30

40

50

60

70

27-32yrs 22-26yrs 17-21yrs 12-16yrs 7-11yrs

CA WILLEM'S Kvaal's

RESULTS

Page 72

Chart 6 : Mean age of males by different age estimation methods


0

5

10

15

20

25

CA Willem's Kvaal's

Male

0

2

4

6

8

10

12

14

16

18

20

CA Willem's Kvaal's

Female

RESULTS

Page 73

DISCUSSION

DISCUSSION

Page 73

Forensic odontology or forensic dentistry is the application of dental knowledge to

those criminal and civil laws that are enforced by police agencies in the criminal justice

system. It is the most unexplored and intriguing branch of forensic sciences.72

There are three important areas of activity embracing the modern forensic

odontology.73 First, comes the evaluation and examination of injuries to the jaws, oral tissues

and to teeth resulting from various causes. Secondly, with a view of the examination of

marks to possible identification or subsequent elimination of a suspect as the predator.

Thirdly, examination of fragments or complete dental remains (including all types of dental

restoration) to a possible identification of the latter.

Several methods have been developed to estimate the age of individuals such as

morphological, biochemical and radiological methods. Most morphological methods require

extractions, and microscopic preparations of at least one tooth from the individual. These

methods cannot be used in living individuals and in cases where it is not acceptable to extract

teeth for ethical, religious, cultural, or scientific reasons.74 Radiographic assessment of age is

a simple, non-invasive and reproducible method that can be employed both on living and

unknown dead, either in identification cases or archaeological investigations.75

Edwin Saunders 76 showed that teeth were more accurate assessment of age than

height. Gustafson 77 made the earliest systematic attempt to estimate age from radiographs,

using macro structural change and is the most popular age estimation test employed by

DISCUSSION

Page 74

forensic odontologists and pathologists. Since then age estimation using dental parameters

has been used in forensic science.76

In 1995,Kvaal et al presented a method to estimate the age on periapical

radiographs, 78 whereas Paewinsky et al verified the applicability of this method on

orthopantomographs.40 In the present study, orthopantomographs were used for age

prediction. Most of the previous studies on panoramic radiographs methods of age prediction

using pulp tooth ratio were carried out on single rooted teeth using regression model. (74,36,40)

The problems associated with orthopantomographs are the superimposition of anatomical

structures especially in the anterior region. Also the assessment of pulp cavity of maxillary

teeth was found to be difficult because the maxillary posterior teeth are often overlapped by

bony structures.71 So, the right mandibular first molar was chosen for the measurement on

intra oral periapical radiograph. Johanson (1971) found that correlation between the age and

height of pulp chamber was somewhat stronger than that reported for all teeth in methods for

age calculation.79

In 1973, Demirjian introduced a method (DemI973) which estimated

chronological age based on developments of seven teeth from the left side of the mandible.

This method has been tested in various populations and has been mostly reported to

overestimate the age of an individual.80 In 2001, Willems et al., evaluated the accuracy of

Demirjian method in Belgian Caucasian population and modified the scoring system when a

significant overestimation was reported.81This modification has been evaluated among

DISCUSSION

Page 75

various communities and has been reported to be more accurate compared with the original

method.

In this present study, the sample was divided into 5 groups, group I was of ages <32,

shows that the mean age and standard deviation were found to be 15.9 in Willem’s method

and 18.88 in Kvaal’s method. group II was of ages <26, shows that the mean age and

standard deviation were found to be 15.49 in Willem’s method and 17.78 in Kvaal’s method.

group III was of ages <21, shows that the mean age and standard deviation were found to be

13.75 in Willem’s method and 19.90 in Kvaal’s method. group IV was of ages <16, shows

that the mean age and standard deviation were found to be 11.85 in Willem’s method and

17.69 in Kvaal’s method. group V was of ages <11, shows that the mean age and standard

deviation were found to be 7.55 in Willem’s method and 17.09 in Kvaal’s method.

In the present study, the overall mean difference between the estimated DA and CA

for males was 15.10 years while for females was 11.88 years. These gender differences in the

entire sample were not statistically significant. When comparison among gender is done,

females mature earlier than males, but the mean difference between DA and CA was not

statistically significant.

Estimated dental age assessment by Willem’s method appeared to underestimate

chronological age both in males and females. However, the difference was greater in females

when compared to males. The estimated by Willem’s method was compared with the “gold

standard” chronological age. The difference was reported as the mean age difference. Mean

difference is considered to be more appropriate measure of accuracy than other measure

DISCUSSION

Page 76

accuracy including correlation coefficient because it allows understanding the difference

between the chronological age and estimated dental age in units, i.e., in decimal years.39

A recent study by RB Mohammed et al., conducted among South Indian children who

concluded that mean dental age showed significant underestimation of 0.7 ± 1.69 years and

0.11 ± 1.3 years in boys and girls respectively [58]. However a study conducted among North

Indian population by Grover et al. reported that the method overestimated age of girls and

boys by 0.24 and 0.36 years respectively.82

Jyotsna et al reported that Willems method underestimated the mean age of males by

0.69 years and females by 0.08 years and showed that females mature earlier than males in

selected population. The mean difference between DA and CA according to Willems method

was 0.39 years and is statistically significant (P < 0.05).83

In Kvaal’s method, the mean value of pulp chamber height and crown root trunk

height, pulpal width at CEJ and width of crown at CEJ was assessed respectively. It was

observed that as the age increases the height of pulp chamber decreases, there was no

significant difference between male and female subjects. The width of the pulp at the level of

cementoenamel junction was also found to decrease with age. The age of the subjects had no

influence on the crown root height and the width of crown at the level of cementoenamel

junction.

In 2000, Schulze et al.,84 investigated the accuracy of the measurements of the

morphological parameters of teeth in orthopantomograms. He opined that vertical

measurements were less reproducible and accurate than horizontal. In the present study, high

DISCUSSION

Page 77

reproducibility was found in both vertical and horizontal measurements. However, maximum

standard deviation was seen in pulp length measurement (vertical parameter). Hence, it could

be suggested that horizontal measurements are more reproducible than vertical

measurements.

Similar age estimation studies were done on OPG by Cameriere et al.,85 and

Bosmans et al.,74 and P value > 0.05, indicated no significant difference between the

estimated and chronological age. In present study, the P value was >0.05, indicating

significantly positive result. Hence, no statistically significant difference was found between

the estimated age and the actual chronological age.

A study based on the concept that with advancing age the size of pulp cavity is

reduced because of secondary dentin deposit had been carried out in 1995 as an indicator of

age by Kvaal et al. 78

A study published by Sharma and Srivastava 86 in 2010 mentions the use of digital

intraoral periapical radiographs for estimation of age of individuals, wherein the authors have

obtained population specific regression formulae to estimate age based on the Kvaal’s

technique. Although the results obtained were slightly different from the original Kvaal’s

study (1995) used on conventional radiographs, the authors have suggested the possibility of

use of this method for age estimation.

Recently, a study has been published by Kanchan-Talreja et al. 87 in which, the

original Kvaal’s formulae have been tested on digital intraoral periapical radiographs and

have led to large errors in age estimation. The authors in the same study have also developed

DISCUSSION

Page 78

population specific formulae which again led to errors in age calculation but to a smaller

extent than applying the original formulae. It is to be noted that the conventional method and

prescribed instrumentation (such as stereomicroscope) used in the original study were not

used in the above mentioned studies which could have been a possible reason for the

variation in the achieved results.

Moreover, it is equally important to realize that no age estimation will accurately

determine the exact age for every individual since development naturally varies between

individuals. Moreover, DA is not same for all children of a specific known age. Most

important aspect of DA estimation is to remember that one should not restrict to only one age

estimation technique, but to apply different techniques available and perform repetitive

measurements and calculations.


Page 80


We started our study with an aim to evaluate the accuracy of two

methods in determining the relation between dental age and chronological age We

selected seventy five patients who were referred from the Department of Orthodontics for

taking Radiographs for treatment purpose. The patients were grouped into five :7 males

and 8 females of age ranging from 27-32 years were in group I; 7 males and 8 females of

age ranging from 22-26 years were in group II; 5 males and 10 females of age ranging

from 17-21 years were in group III; 2 males and 13 females of age ranging from 12-16

years were in group IV; 3 males and 12 females of age ranging from 7-11 years were in

group V.

CA of an individual was calculated by subtracting the birth date from the

date on which the radiographs were exposed for that particular individual. The dental age

was determined using orthopantamographs by Willem’s method and using Intra oral

periapical radiograph by Kvaal’s method. The results were analysed. In this study,

significant relation was found between estimated DA and CA in Willem method (p-0.00)

and Kvaal’s method (p-0.05). Both the methods seems to be applicable in estimating age

of both genders.


Page 81

LIMITATIONS OF THE STUDY

The difference between the Chronological age and Calculated age is due to tooth

formation stages are not equally spaced during growth and are not of equal duration.

When a three-dimensional image is projected on a two-dimensional film receptor, a

discrepancy may occur in the morphologic measurements of the tooth.

A proper visual discrimination between formation stages is necessary, because it remains

subjective and even a one stage difference may have an impact on DA.

BIBLIOGRAPHY

BIBLIOGRAPHY

Page 82

1. Suman Jaishankar, Jaishankar N, Shanmugam S Lip prints in personal identification.

JIADS 2010;1; 4: 23-6.

2. Shrestha M et al.Comparative Evaluation of Two Established Age Estimation Techniques

(Two Histological and Radiological) by Image Analysis Software using Single Tooth. J

Forensic Res 2014:5

3. Vahanwahal SP, Parekh DK. Study of lip prints as an aid to forensic methodology. J

Indian Dent Assoc 2000;71:269 71.

4. Amedo O. The role of dentist in the identification of the victims of the catastrophe of the

“ Bazar de la Charite” 1897.Dent Cosm 1897;39:905‑12

5. Mishra G. Lip prints. UP State Dent J 2008;25:18-22.

6. Koshy S, Tandon S et al Dental age assessment: the applicability of Demirjian's method

in south Indian children. Forensic Sci Int 1998:94: 73-85.

7. Liversidge HM, Herdeg B, Rösing FW.Dental age estimation of non-adults. A review of

methods and principles. Dental anthropology: fundamentals, limits and prospects 1998:

419–442

8. Agarwal, et al.: Radiographic study for age estimation. Journal of Forensic Dental

Sciences 2012 : 4 (2)

9. Landa MI, Garamendi PM, Botella MC, Aleman I. Application of method of Kvaal et al.

to digital orthopantomograms. Int J Legal Med 2009;123:123-8.

10. Mani SA, Naing L, John J, Samsudin AR (2008) Comparison of two methods of dental

age estimation in 7–15-year old Malays. Int J Paediatr Dent2008;18: 380-388.

11. Amandeep Singh.Age estimation from physiological changes of teeth. J Indian Forensic

Sci 2004; 26: 0971-0973

12. Sumit S, Upender K, Atul M, Sharma GK.Determination of age from teeth using index

value of attrition. J Forensic Med Toxicol 2003; 1: 0973-1970.

13. Dayal PK. Textbook of Forensic Odontology 1998.First edition, Paras Medical Publisher

14. Miles AEW. The assessment of age from dentition. Roy. Soc. Med.1958; 51:1057.

15. Nystrom M, Peck L, Kleemola – Kujala E, Evalahti, Kataja M.Age estimation in small

children: reference values based on counts of deciduous teeth in Finns. ForensicSci

Int.2000; 110:179-88

BIBLIOGRAPHY

Page 83

16. Olze A, Reisinger W, Geserick G, Schmeling A.Age estimation of unaccompanied

minors Part II. Dental aspects Forensic Science International 2006; 159:65–67

17. Orhan K, Ozer L, Orhan AI, Dogan S, Paksoy CS.Radiographic evaluation of third molar

development in relation to chronological age among Turkish children

and youth, Forensic Science International 2007; 165: 46–51

18. Rozkovkova, Markova.Third molar as an age indicator in young individuals. Prague Med

Rep.2005;106(4):367-98

19. Griffin. R.C, H.Moody, K.E.H. Penkman, M.J. Collins.The application of amino acid

racemization in the acid soluble fraction of enamel to the estimation of age of human

teeth.Forensic science international 2008;175: 11-16.

20. Priyadarshini C, Puranik M P, Uma S R. Dental Age Estimation Methods: A Review. Int

J Adv Health Sci 2015;1(12):19-25.

21. Shruti D Nayak,Renjith George,Amarnath Shenoy,Sivapathasundaram B.Age Estimation

n Forensic Dentistry-A Review.IJSR 2014;3(4):333-38

22. Erbudak, Hümeyra & Ozbek, Murat & Uysal, Serdar & Karabulut, Erdem. Application of

Kvaal et al.'s Age Estimation Method to Panoramic Radiographs from Turkish

Individuals. Forensic science international. 2012;219:141-146

23. Drusini, A. G., Toso, O. and Ranzato, C. The coronal pulp cavity index: A biomarker for

age determination in human adults. Am. J. Phys. Anthropol.,1997; 103: 353–363.

24. Kolltveit KM, Solheim T, Kvaal SI.Methods of measuring morphological parameters in

dental radiographs. Comparison between image analysis and manual measurements.

Forensic Science International 1994;94:87-95.

25. Kedici SP, SaadetAtsii, Gokdemir K, Sarikaya Y, Gurbiiz F. Micrometric measurements

by scanning electron microscope (SEM) for dental age estimation in adults, J Forensic

Odontostomatol 2000;18:22-26

26. Willems G. A review of the most commonly used dental age estimation techniques. J

Forensic Odontostomatol. 2001;19:9–17.

27. Valenzuela A, Martin-De Las Heras S, Mandojana JM, De Dios Luna J, Valenzuela M,

Villanueva E. Multiple regression models for age estimation by assessment of

morphologic dental changes according to teeth source. Am J Forensic Med Pathol.

2002;23(4):386-9.

http://www.sciencedirect.com/science/article/pii/S0379073898000589



https://www.ncbi.nlm.nih.gov/pubmed/?term=Valenzuela%20A%5BAuthor%5D&cauthor=true&cauthor_uid=12464819

https://www.ncbi.nlm.nih.gov/pubmed/?term=Martin-De%20Las%20Heras%20S%5BAuthor%5D&cauthor=true&cauthor_uid=12464819

https://www.ncbi.nlm.nih.gov/pubmed/?term=Mandojana%20JM%5BAuthor%5D&cauthor=true&cauthor_uid=12464819

https://www.ncbi.nlm.nih.gov/pubmed/?term=De%20Dios%20Luna%20J%5BAuthor%5D&cauthor=true&cauthor_uid=12464819

https://www.ncbi.nlm.nih.gov/pubmed/?term=Valenzuela%20M%5BAuthor%5D&cauthor=true&cauthor_uid=12464819

https://www.ncbi.nlm.nih.gov/pubmed/?term=Villanueva%20E%5BAuthor%5D&cauthor=true&cauthor_uid=12464819

https://www.ncbi.nlm.nih.gov/pubmed/?term=Multiple+regression+models+for+age+estimation+by+assessment+of+morphologic+dental+changes+according+to+teeth+source.

BIBLIOGRAPHY

Page 84

28. Takasaki T, Tsuji A, Ikeda N, Ohishi M. Age estimation in dental pulp DNA based on

human telomere shortening. Int J Legal Med. 2003;117(4):232-4.

29. Vandevoort FM, Bergmans L, Cleynenbreugel JV, et al.Age calculation using X-ray

microfocus computed tomographical scanning of teeth: a pilot study. J Forensic Sci

2004;49:787–790

30. Wittwer-Backofen U, Gampe J, Vaupel JW. Tooth cementum annulation for age

estimation: Results from a large known-age validation study. Am J Phys Anthropol.

2004;123:119–29.

31. Paewinsky E, Pfeiffer H, Brinkmann B.Quantification of secondary dentine formation

from orthopantomograms—a contribution to forensic age estimation methods in adults.

Int J Legal Med 2005; 119: 27-30.

32. Bosmans, Nathalie & Peirs, Ann & Aly, Medhat & Willems, Guy.The application of

Kvaal's dental age calculation technique on panoramic dental radiographs. Forensic

science international.2005; 153.

33. Age Estimation by Measurements of Developing Teeth: Accuracy of Cameriere’s

Method on a Brazilian Sample Journal of Forensic Sciences 2011;56(6)

34. Balwant Rai, SC Anand. Tooth developments: An Accuracy of Age Estimation of

Radiographic Method. World Journal of Medical Sciences 2006; 1: 130-132.

35. Kagerer P and Grupe G.Age at death diagnosis and determination of life history

parameters by incremental lines in human dental cementum as an identification aid.

Forensic Science International 2001.; 118:75–82.

36. Age estimation using pulp/tooth area ratio: A digital image analysis

Singaraju Sasidhar, Sharada P. 2009; 1(1): 37-41

37. Olze et al .Dental age estimation based on third molar Eruption in first nations people of

Canada. J Forensic Odontostomatol 2010; 28:1:32-38

38. Babshet M, Acharya AB, Naikmasur VG. Age estimation in Indians from pulp/tooth area

ratio of mandibular canines. Forensic Sci Int. 2010;197:125.e1–4. [

39. Jayaraman J1, King NM, Roberts GJ, Wong HM. Dental age assessment: are Demirjian's

standards appropriate for southern Chinese children?J Forensic Odontostomatol.

2011;29(2):22-8.

https://www.ncbi.nlm.nih.gov/pubmed/?term=Takasaki%20T%5BAuthor%5D&cauthor=true&cauthor_uid=12838429

https://www.ncbi.nlm.nih.gov/pubmed/?term=Tsuji%20A%5BAuthor%5D&cauthor=true&cauthor_uid=12838429

https://www.ncbi.nlm.nih.gov/pubmed/?term=Ikeda%20N%5BAuthor%5D&cauthor=true&cauthor_uid=12838429

https://www.ncbi.nlm.nih.gov/pubmed/?term=Ohishi%20M%5BAuthor%5D&cauthor=true&cauthor_uid=12838429

https://www.ncbi.nlm.nih.gov/pubmed/12838429

https://link.springer.com/article/10.1007/s00414-004-0492-x



http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1556-4029

http://onlinelibrary.wiley.com/doi/10.1111/jfo.2011.56.issue-6/issuetoc

https://www.ncbi.nlm.nih.gov/pubmed/?term=Jayaraman%20J%5BAuthor%5D&cauthor=true&cauthor_uid=22717910

https://www.ncbi.nlm.nih.gov/pubmed/?term=King%20NM%5BAuthor%5D&cauthor=true&cauthor_uid=22717910

https://www.ncbi.nlm.nih.gov/pubmed/?term=Roberts%20GJ%5BAuthor%5D&cauthor=true&cauthor_uid=22717910

https://www.ncbi.nlm.nih.gov/pubmed/?term=Wong%20HM%5BAuthor%5D&cauthor=true&cauthor_uid=22717910


BIBLIOGRAPHY

Page 85

40. Saxena S et al. Age estimation of Indian adults from Orthopantomographs. Braz Oral

Res. 2011;25(3):225-9

41. N. Jagannathan et al. Age estimation in an Indian population using pulp/tooth volume

ratio of mandibular canines obtained from cone beam computed tomography. J Forensic

Odontostomatol 2011;29:1:1

42. Kumar VJ,Gopal KS. Reliability of age estimation using Demirjian's 8 teeth method and

India specific formula. J Forensic Dent Sci. 2011; 3(1): 19–22.

43. Chandramala R, Sharma R, Khan M, Srivastava A (2012) Application of Kvaal’s

Technique of Age Estimation on Digital Panoramic Radiographs. Dentistry 2012;2:142.

44. Agarwal N, Ahuja P, Abhishek S,Anil S. Age estimation using maxillary central incisors:

A radiographic study.J Forensic Dent Sci. 2012 ; 4(2): 97–100.

45. Nur B, Adem Kusgoz, Mehmet Bayram, Mevlut Celikoglu, Metin Nur, Saadettin

Kayipmaz,Sina Yildirim. Validity of demirjian and nolla methods for dental age

estimation for Northeastern Turkish children aged 5–16 years old. Med Oral Patol Oral

Cir Bucal. 2012; 17(5): e871–e877.

46. .Erbudak HO, Ozbek M, Uysal S, Karabulut E.Application of Kvaal et al.’s age

estimation method to panoramic radiographs from Turkish individuals. Forensic Sci Int

2012;219: 141-146.

47. Mathew DJ, S Rajesh, Elizabeth Koshi, Lakshmi E Priya, Amal S Nair et al.Adult

forensic age estimation using mandibular first molar radiographs: A novel technique. J

Forensic Dent Sci. 2013; 5(1): 56–59

48. Djukic K, Zelic K, Milenkovic P, Nedeljkovic N, Djuric M. Dental age assessment

validity of radiographic methods on Serbian children population.Forensic SciInt

2013.231: 398.

49. Sarkar S, Kailasam S, Mahesh Kumar P. Accuracy of estimation of dental age in

comparison with chronological age in Indian population--a comparative analysis of two

formulas. J Forensic Leg Med. 2013;20(4):230-3

50. Ambarkovaa V, Galic I, Vodanovićc M, Biočina-Lukendad D, Brkićc H. Dental age

estimation using Demirjian’s and Willems methods: cross-sectional study on children

from the Former Yugoslav Republic of Macedonia. Forensic Sci Int 2014;234:187

https://www.ncbi.nlm.nih.gov/pubmed/?term=Kumar%20VJ%5BAuthor%5D&cauthor=true&cauthor_uid=22022134

https://www.ncbi.nlm.nih.gov/pubmed/?term=Gopal%20KS%5BAuthor%5D&cauthor=true&cauthor_uid=22022134

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3190434/

https://www.ncbi.nlm.nih.gov/pubmed/?term=Agarwal%20N%5BAuthor%5D&cauthor=true&cauthor_uid=23741151

https://www.ncbi.nlm.nih.gov/pubmed/?term=Ahuja%20P%5BAuthor%5D&cauthor=true&cauthor_uid=23741151


https://www.ncbi.nlm.nih.gov/pubmed/?term=Nur%20B%5BAuthor%5D&cauthor=true&cauthor_uid=22549686

https://www.ncbi.nlm.nih.gov/pubmed/?term=Kusgoz%20A%5BAuthor%5D&cauthor=true&cauthor_uid=22549686

https://www.ncbi.nlm.nih.gov/pubmed/?term=Bayram%20M%5BAuthor%5D&cauthor=true&cauthor_uid=22549686

https://www.ncbi.nlm.nih.gov/pubmed/?term=Celikoglu%20M%5BAuthor%5D&cauthor=true&cauthor_uid=22549686

https://www.ncbi.nlm.nih.gov/pubmed/?term=Nur%20M%5BAuthor%5D&cauthor=true&cauthor_uid=22549686

https://www.ncbi.nlm.nih.gov/pubmed/?term=Kayipmaz%20S%5BAuthor%5D&cauthor=true&cauthor_uid=22549686

https://www.ncbi.nlm.nih.gov/pubmed/?term=Kayipmaz%20S%5BAuthor%5D&cauthor=true&cauthor_uid=22549686

https://www.ncbi.nlm.nih.gov/pubmed/?term=Yildirim%20S%5BAuthor%5D&cauthor=true&cauthor_uid=22549686



https://www.ncbi.nlm.nih.gov/pubmed/?term=Mathew%20DG%5BAuthor%5D&cauthor=true&cauthor_uid=23960417

https://www.ncbi.nlm.nih.gov/pubmed/?term=Rajesh%20S%5BAuthor%5D&cauthor=true&cauthor_uid=23960417

https://www.ncbi.nlm.nih.gov/pubmed/?term=Koshi%20E%5BAuthor%5D&cauthor=true&cauthor_uid=23960417

https://www.ncbi.nlm.nih.gov/pubmed/?term=Priya%20LE%5BAuthor%5D&cauthor=true&cauthor_uid=23960417

https://www.ncbi.nlm.nih.gov/pubmed/?term=Nair%20AS%5BAuthor%5D&cauthor=true&cauthor_uid=23960417






https://www.ncbi.nlm.nih.gov/pubmed/?term=Sarkar%20S%5BAuthor%5D&cauthor=true&cauthor_uid=23622465

https://www.ncbi.nlm.nih.gov/pubmed/?term=Kailasam%20S%5BAuthor%5D&cauthor=true&cauthor_uid=23622465

https://www.ncbi.nlm.nih.gov/pubmed/?term=Mahesh%20Kumar%20P%5BAuthor%5D&cauthor=true&cauthor_uid=23622465


BIBLIOGRAPHY

Page 86

51. Limdiwala PG, et al. Age estimation by using dental radiographs.. J Forensic Dent Sci.

2013.

52. Mohammed RB, Sanghvi P, Perumalla KK, Srinivasaraju D, Srinivas J, et al.Accuracy of

four dental age estimation methods in southern Indian children. J Clin Diagn Res 2015:

HC01-08.

53. Caroline Edward Ayad, Hiba Mahgoub Hamid, Elsafi Ahmed Abdalla & Samih Awad

Kajoak. Estimation of Age for Sudanese Adults using Orthopantomographs. Global

Journal of Medical research : J Dentistry and Otolaryngology 2014;14(1)

54. Mostafa M Afify,Mohamed K Zayet,Naglaa F Mahmoud,Ahmed R Ragab. Age

Estimation from Pulp/Tooth Area Ratio in Three Mandibular Teeth by Panoramic

Radiographs: Study of an Egyptian Sample.J Forensic Res 2014, 5:3

55. Aída C. Medina,Lucila Blanco. Comparison of Demirjian and Willems methods. 34 Acta

Odontol. Latinoam. 2014;27(9) :34-41

56. Ioannis N. Tsatsoulis, Christos G.Filippatos,Evangelos G.Kontakiotis: Estimation

radiographic angles and distances in coronal part of mandibular molars: A study of

panoramic radiographs using EMAGO software, Eur J Dent 2014;8(1):90-94

57. Manjushree Juneja, Yashoda B. K. Devi, N. Rakesh,,Saurabh Juneja. Age estimation

using pulp/tooth area ratio in maxillary canines-A digital image analysis. J Forensic Dent

Sci. 2014; 6(3): 160–165.

58. Mohammed RB, Krishnamraju P V, Prasanth P S, Sanghvi P, Lata Reddy M A, Jyotsna

S. Dental age estimation using Willems method: A digital orthopantomographic study.

Contemp Clin Dent 2014;5:371-6

59. Jurca A. Dental age assessment using Demirjian′s method - A radiographic study. Eur Sci

J 2014;10:51-60.

60. Patil SK, Mohankumar KP, Donoghue M. Estimation of age by Kvaal's technique in

sample Indian population to establish the need for local Indian-based formulae. J

Forensic Dent Sci. 2014;6:166–70.

61. Javadinejad S, Sekhavati H, Ghafari R. A Comparison of the accuracy of four age

estimation methods based on panoramic radiography of developing teeth. J Dent Res

Dent Clin Dent Prospects 2015;9:72-8

https://www.ncbi.nlm.nih.gov/m/pubmed/24255560/?i=2&from=/20922158/related

https://www.ncbi.nlm.nih.gov/pubmed/?term=Juneja%20M%5BAuthor%5D&cauthor=true&cauthor_uid=25177137

https://www.ncbi.nlm.nih.gov/pubmed/?term=Devi%20YB%5BAuthor%5D&cauthor=true&cauthor_uid=25177137

https://www.ncbi.nlm.nih.gov/pubmed/?term=Rakesh%20N%5BAuthor%5D&cauthor=true&cauthor_uid=25177137

https://www.ncbi.nlm.nih.gov/pubmed/?term=Juneja%20S%5BAuthor%5D&cauthor=true&cauthor_uid=25177137



BIBLIOGRAPHY

Page 87

62. CH. Sai Kiran, R. Sudhakara Reddy, T. Ramesh, N. Sai Madhavi, and K. Ramya.

Radiographic evaluation of dental age using Demirjian's eight-teeth method and its

comparison with Indian formulas in South Indian population. J Forensic Dent Sci. 2015;

7(1): 44–48.

63. Priya E.Applicability of Willem’s Method of Dental Age Assessment in 14 Years

Threshold Children in South India - A Pilot Study. J Forensic Res 2015;S4:S4-002.

64. Gupta S, Mehendiratta M, Rehani S, Kumra M, Nagpal R, Gupta R. Age estimation in

Indian children and adolescents in the NCR region of Haryana: A comparative study. J

Forensic Dent Sci 2015;7:253-8

65. Lee, Sang-Seob & Byun, Young-Sub & Jin Park, Myung & Choi, Jong-Hoon & Yoon,

Chang-Lyuk & Park, Myung Jin.The chronology of second and third molar development

in Koreans and its application to forensic age estimation. International journal of legal

medicine.2010; 124. 659-65.

66. Uday, Ginjupally & Ramaswamy, P & Khaitan, Tanya & J. Srilakshmi MDS, Dr &

Pattipati, Sreenivasulu,N.V. Santhosh. Age estimation based on variation in the pulp

cavity of maxillary incisors - a radiographic study. World Journal of Pharmaceutical

Research.2015; 4. 2720-2728.

67. El Morsi DA, Gaballah G, Ibrahim W, Tawfik AI.Sex Determination in Egyptian

Population from Scapula by Computed Tomography. J Forensic Res 2017; 8:376.

68. Indira AP, Shashikala, Nagaraj T, Santosh HN. Age estimation of adults using dental

pulp: A cross-sectional radiographic study. J Adv Clin Res Insights 2015;2:131-134.

69. Talabani RM, Baban MT, Mahmood MA. Age estimation using lower permanent first

molars on a panoramic radiograph: A digital image analysis. J Forensic Dent Sci

2015;7:158-62

70. Mittal S, Nagendrareddy SG, Sharma ML, Agnihotri P, Chaudhary S, Dhillon M. Age

estimation based on Kvaal's technique using digital panoramic radiographs. J Forensic

Dent Sci. 2016;8(2):115.

71. Kumar, Nerella Narendra et al.Digitized morphometric analysis of dental pulp of

permanent mandibular second molar for age estimation of Davangere population Journal

of Forensic and Legal Medicine , 39 , 85 - 9

https://www.ncbi.nlm.nih.gov/pubmed/?term=Kiran%20CS%5BAuthor%5D&cauthor=true&cauthor_uid=25709319

https://www.ncbi.nlm.nih.gov/pubmed/?term=Reddy%20RS%5BAuthor%5D&cauthor=true&cauthor_uid=25709319

https://www.ncbi.nlm.nih.gov/pubmed/?term=Ramesh%20T%5BAuthor%5D&cauthor=true&cauthor_uid=25709319

https://www.ncbi.nlm.nih.gov/pubmed/?term=Madhavi%20NS%5BAuthor%5D&cauthor=true&cauthor_uid=25709319

https://www.ncbi.nlm.nih.gov/pubmed/?term=Ramya%20K%5BAuthor%5D&cauthor=true&cauthor_uid=25709319


https://www.ncbi.nlm.nih.gov/pubmed/?term=Mittal%20S%5BAuthor%5D&cauthor=true&cauthor_uid=27555738

https://www.ncbi.nlm.nih.gov/pubmed/?term=Nagendrareddy%20SG%5BAuthor%5D&cauthor=true&cauthor_uid=27555738

https://www.ncbi.nlm.nih.gov/pubmed/?term=Sharma%20ML%5BAuthor%5D&cauthor=true&cauthor_uid=27555738

https://www.ncbi.nlm.nih.gov/pubmed/?term=Agnihotri%20P%5BAuthor%5D&cauthor=true&cauthor_uid=27555738

https://www.ncbi.nlm.nih.gov/pubmed/?term=Chaudhary%20S%5BAuthor%5D&cauthor=true&cauthor_uid=27555738

https://www.ncbi.nlm.nih.gov/pubmed/?term=Dhillon%20M%5BAuthor%5D&cauthor=true&cauthor_uid=27555738



BIBLIOGRAPHY

Page 88

72. Keiser-Neilsen S. Bristol: John Wright and Sons.Person Identification by Means of Teeth

1980.

73. Keiser-Nielsen S. Forensic odontology. Int Dent J. 1968;18:668–83.

74. Bosmans N, Ann P, Aly M, Willems G. The application of Kvaal's dental age calculation

technique on panoramic dental radiographs. Forensic Sci Int. 2005;153:208–12.

75. Patil Karthikeyal, Mahima VG, Malleshi SN. Maxillary lateral incisor as biomarker of

age- An in-vivo Radiographic study. Indian J Forensic Odontol. 2009;2:17–20.

76. Ajmal M, Mody B, Gopa Kumar. Age Estimation using Three established methods.

Forensic Science International 2001;122: 150-154.

77. Gustafson G.Age determination on teeth. J Am Dent Assoc1950; 41: 45-54

78. Kvaal SI, Kolltveit KM, Thomsen IO, Solheim T. Age estimation of adults from dental

radiographs. Forensic Sci Int. 1995;74:175–85.

79. Solheim T.Amount of secondary dentin as an indicator of age.Scand J Dent Res

1992;100:193-9

80. Demirjian A, Goldstein H, Tanner JM. A new system of dental age assessment. Hum Biol

1973;45:211-27

81. Willems G, Van Olmen A, Spiessens B, Carels C. Dental age estimation in Belgian

children: Demirjian's technique revisited. J Forensic Sci. 2001;46:893–5.

82. Grover S, Marya CM, Avinash J, Pruthi N.Estimation of dental age and its comparison

with chronological age: accuracy of two radiographic methods. Med Sci Law 2012;52:

32-35.

83. S Jyotsna, PV Krishnamraju, M Asha Lata Reddy, Rezwana Begum Mohammed et

al.Dental age estimation using Willems method: A digital orthopantomographic study.

Contemporary Clinical Dentistry 2014;5(3):371-376

84. Schulze R, Krummenauer F, Schalldach F, Hoedt B. Precision and accuracy of

measurements in digital panoramic radiography. Dentomaxillofacial Radiol 2000;29:52-

6.

85. Cameriere R, Ferrante L, Cingolani M. Variations in pulp/tooth area ratio as an indicator

of age: A preliminary study. J Forensic Sci 2004;49:317-9

86. Sharma R, Srivastava A.Radiographic evaluation of dental age of adults using Kvaal’s

Method. J Forensic Dent Sci2010; 2: 22-26.



http://europepmc.org/abstract/med/15428197

BIBLIOGRAPHY

Page 89

87. Kanchan-Talreja P, Acharya AB, Naikmasur VG.An assessment of the versatility of

Kvaal’s method of adult dental age estimation in Indians. Arch Oral Biol 2012; 57: 277-

284.

.

.

ANNEXURE

ANNEXURE

Page 91

ANNEXURE – I

INFORMED CONSENT

I_____________________ hereby declare that I clearly understood the procedures of the

study. Also, I declare that I give permission for the above mentioned

individual/organization/hospital to do the procedure to the individual/organization listed above.

Signature ___________ Date __________

I have explained the above and answered all questions asked by the participant

Signature ___________ Date __________

ANNEXURE

Page 92

ANNEXURE – II

ANNEXURE

Page 93

ANNEXURE – III

Urkund Analysis Result Analysed Document: complete dissertation - Corrections.docx (D34300479)Submitted: 1/3/2018 9:32:00 AM Submitted By: [email protected] Significance: 5 %

Sources included in the report:

SAAR och NIBE.pdf (D13226522) Liljana Simonsson Mastersarbete 2013.docx (D12369274) Liljana Simonsson Mastersarbete 2013.docx (D11901646) http://mb.cision.com/Main/14691/2328151/710950.pdf http://www.aapd.org/assets/1/7/Periodicity-RhodeIsland.pdf https://link.springer.com/article/10.1007/s00414-004-0492-x http://www.rguhs.ac.in/cdc/onlinecdc/uploads/02_D032_18607.doc https://www.researchgate.net/publication/51369645_Quantification_of_secondary_dentine_formation_from_orthopantomograms_-_A_contribution_to_forensic_age_estimation_methods_in_adults https://www.researchgate.net/publication/15640872_Age_estimation_of_adult_from_radiographs https://www.sciencedirect.com/science/article/pii/037907389501760G https://www.readbyqxmd.com/read/7557754/age-estimation-of-adults-from-dental-radiographs https://www.uhccommunityplan.com/content/dam/communityplan/healthcareprofessionals/providerinformation/RI-Provider-Information/RI_Early_Periodic_Screening_Diagnosis_Treatment.pdf https://www.bafo.org.uk/wp-content/uploads/2011-11-26-recent-publications.pdf http://www.pubpdf.com/pub/25177137/Age-estimation-using-pulptooth-area-ratio-in-maxillary-canines-A-digital-image-analysis https://pdfs.semanticscholar.org/cdeb/e67c3a1d85b7fb4807a2561e7231961af6e8.pdf

Instances where selected sources appear:

38

U R K N DU

COMPARISON OF TWO METHODS IN ESTIMATING THE RELATION BETWEEN DENTAL AGE AND CHRONOLOGICAL AGE INTRODUCTION Personal identification is becoming increasingly important not only in legal medicine but also in criminal investigation, identification and Genetic Research.1It is an important basis for differentiating guilty from innocent in legal issues, for ethical issues and for declaration of death reports and the basis for probing into criminal cases, mass disaster or war victims.2 The mouth has been identified as the organ system “where it all begins.” Forensic odontology, or forensic dentistry, was defined by Keiser- Neilson in 1970

as “a branch of forensic medicine

which in the interest of justice deals with the proper handling and examination of dental evidence and with

the proper evaluation and presentation of the dental findings.”3

Dr. Oscar Amoedo was considered as the father of the forensic odontologist. The thesis done by him entitled ‘L’ Art Dentaire en Medicine Leagale’ to the faculty of medicine earned him a doctorate. This book is the first comprehensive text on forensic odontologist.4 The traditional methods of personal identification include anthropometry, finger prints, sex determination, estimation of age, measurement of height, identification of a specific individual, and differentiation by blood groups.5 The accurate estimation of age at the time of death with the help of dental remains is an important parameter for identification. 2 Age plays an important role in various fields such as forensic science, various social and legal settings and treatment planning in clinical dentistry.6 The age of a person can be determined by the degree of maturation of the different tissue systems of an individual. Laccasagne in 1889 who was the

one first started using the changes occuring

in the teeth of adults for age estimation.8 . In 1925,Bodecker extended that some morphological alternations occurring in teeth could also be related

with age increases.9 There are so many literature reports are available for age assessment using different morphological and radiological techniques. When compared to other skeletal and sexual maturity indicators, dental age estimation seems to be less variable and gained acceptance.10 Teeth are considered to be the most durable and resilient part of the skeleton and so many ways of examining the teeth are also available makes it a unique part of human body.11Sometimes incase of extensive destruction to the dead bodies such as burnt cases, teeth may be the only means of identification .12

Adult

teeth consists of enamel as the outermost covering of tooth crown and dentin underneath, both of which are hard tissues resistant to decomposition, followed by pulp as the innermost soft tissue core. Likewise cementum is the outermost covering for the surface of root which is also resistant to decomposition. 2

2

U R K N DU complete dissertation - Corrections.docx (D34300479)

Dental age (DA) determination is important because it

serves as an important tool in estimating

the CA of a child with an unknown birth date. Among the most reliable tools in

age estimation ,teeth are considered as well founded method especially in the first two decades. Mostly age determination depends on the stages of development of tooth and its structures.13

Methods of

Dental Age Estimation 14 Different methods are employed from dentition for age determination. Dental age estimation methods may be classified as: A. According to the state of development of the dentition: Forming dentition Fully formed dentition. B. According to the technique of investigation: Visual or Clinical analysis Radiographic analysis Histological analysis Physical and chemical analysis

i. Clinical or visual method:

On Visual observation, functional alternations such as attrition can give a roughly close age estimation. ii. Radiographic method: Radiographs can provide the obscure result using stages of tooth development.

iii. Histological method: On Histological analysis, preparation of the tissues are needed for microscopic examination, in which age estimation could be more accurately .This is mostly indicated in postmortem situations. iv. Physical and chemical analysis: An hypothesis in which the alternations

in ion levels determines with age have been proposed.These techniques are not

yet of great value, further research to be proceeded for further development.

Dental

age estimation can be grouped into 3 categories:(15-21) 1. Dental age estimation in prenatal, neonatal and early postnatal child 2. Dental age estimation in children and adolescents 3. Dental

age

estimation in adults

1. Dental age estimation in prenatal, neonatal and early postnatal child - Dental age assessment from the neonatal line - Dental age assessment based enamel and dentin thickness from the neonatal line -

Dental eage assessment from the incremental lines -Dental

3


age assessment from the weight of the development dentition

2. Dental age estimation of children and adolescents -Dental age estimation using charts prepared from population surveys -Dental age assessment by examining the incremental patterns of tooth - Age estimation in third molars 3. Dental age estimation in adults -Gustafson’s method -Dental age estimation using color of the teeth -Dental age estimation using fluorescence from dentine and cementum -Dental age estimation based on human telomere shortening in pulp DNA - Radiographic method

AIMS AND OBJECTIVES • To determine dental age by radiographic methods in Digital Orthopantamograph using Willem’s method and in Intra oral periapical radiograph using Kwaal’s method • To find out the accuracy of two methods in determining the relation between dental age and chronological age


Sigrid I.Kvaal et al (1995) 22 conducted study using 100 periapical radiographs which were taken using paralleling technique and the samples were collected from clinics of dental faculty in Oslo. The age ranging from 20-87 years were included in the study. Tooth / root length, the pulp /root length, as well as the pulp/root width at three levels were calculated from the radiographs of central, lateral incisors and second premolars

of maxillary arch, and lateral incisors, canines and first premolars of mandibular arch

by using Vernier calipers. All five ratios had significant influence on age except the ratio between length of tooth and root and coefficient of determination (r2) for the regression was

greatest.

Andrea G.Drusini et al (1997) 23 examined panoramic radiographs of 425 premolars and 421 molars to measure the coronal height and the height of coronal pulp cavity and 100 teeth from 100 year old skeletons. For panoramic study,213 males and 220 females of known age ranging from 9-76 years were included. Correlations were slightly higher in males than females with an error of +5 years in 81.4% of cases. In historical sample, error of +5 years in 70.37% of cases of molars. It was found that this method can be applied to estimate the age in both living individuals and skeletal material of unknown age.

Kolltveit and Solheim et al.(1998) 24 had conducted a study to compare the reliability of manual measurements (vernier calipers using a stereomicroscope) with that of computer-assisted measurements (CAM) of morphological parameters using Image analysis software in

dental radiographs. Ratios calculated from the linear measurements of “tooth” by “pulp” showed a weaker correlation with age when the image analysis program was employed than did ratios based on conventional measurements (without image analysis) of the same. The main source of errors in measurement seemed to be difficulties in recognition of the reference points on the radiographs when viewed on the monitor, and therefore in defining the line to be measured.

4


Sema Kedici P et al (2000) 25 calculated 20 measurements of various variables in incisor using a SEM micrometric scaler.

Using multiple regression method, results were statistically correlated with age. From the calculations, a formula for age estimation was derived which gave statistically acceptable results.

Willems et al (2001)26 conducted a study was to evaluate the accuracy of Demirjian’s dental age estimation in children in a Belgian Caucasian population and to adapt the scoring system in case of a significant overestimation as frequently reported.2523 orthopantomograms of 1265 boys and 1258 girls, of which 2116 (1029 boys and 1087 girls) were used for estimating the dental age with the Demirjian’s technique. The 407 other orthopantomogram were beyond the original age limit. A second sample of 355 orthopantomograms was used to evaluate the accuracy of the original method and the adapted method. A signed-rank test was performed to search for significant age differences

between the obtained dental age and the chronological age. A weighted ANOVA was performed in order to adapt the scoring system for this Belgian population. The overestimation of the chronological age was confirmed. The adapted scoring system resulted in new age scores expressed in years and in a higher accuracy compared to the original method in Belgian Caucasians.

Martin-de las Heras et al (2002) 27 and coworkers, who

conducted a study of objective method for estimation of age using spectroradiometry for dentine color measurements. Study done on 250 teeth collected from patients age ranging

from 10 to 89 years was determined. Color measurements were done as suggested in the International Commission on Illumination1931.Chromaticity coordinates, luminance, whiteness index and yellowness index were obtained.

Linear regression analyses were established to correlate

between these colorimetric variables and aging. The mathematical model with correlation coefficients ranging from 0.53 to 0.75

fit with the variables.

Tomoya Takasaki et al (2003) 28 estimated the age based on variables present in teeth which has received significant consideration within the interest of forensic science. They determined the telomere length for age estimation. They found that the average TRF length

in dental pulp DNA

showed a tendency to shortening with aging. Their findings confirmed that based on dental pulp DNA

telomere shortening, is a novel approach in age estimation

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of the subject at the time of death.

Vandevoort F.M et al (2004) 29 calculated the

volume ratio of pulp versus tooth volume and

correlated the dental age with an individual’s chronological age.

An X-ray micro focus computed tomography unit with spatial resolution

of 25μm were used. From 25 patients of known age,43 single root teeth were extracted. Custom-made analysis software was used by With the help of two examiners, they have obtained numerical values for volume of pulp and tooth. Their ratios

was calculated and statistically analysed. No significant intra- or inter-examiner differences were found.

Wittwer-Backofen et al (2004) 30 conducted a study

of estimating age using tooth cementum annulations technique. This study needs to extract the teeth and sectioning the teeth, so it is mostly used on dead people.

Paewinsky et al (2005) 31 conducted a study on 168

panoramic radiographs of patients.

0: https://link.springer.com/article/10.1007/s00414-004-0492-x 70%

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2: https://www.researchgate.net/publication/51369645_Quantification_of_secondary_dentine_formation_from_orthopantomograms_-_A_contribution_to_forensic_age_estimation_methods_in_adults 70%

3: https://www.researchgate.net/publication/15640872_Age_estimation_of_adult_from_radiographs 87%

4: https://www.sciencedirect.com/science/article/pii/037907389501760G 87%

5: https://www.readbyqxmd.com/read/7557754/age-estimation-of-adults-from-dental-radiographs 87%

Pulp/tooth length, pulp/root length and pulp/root width at three

varying root levels

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were calculated in



maxillary central and lateral incisors and second premolars,

whereas in mandibular arch, lateral incisors, canines and first premolars

are analysed. Significant correlation to the chronological age was achieved in



the


width ratios of the pulp cavity and highest coefficient of determination obtained in the upper lateral incisors.

Nathalie Bosmans et al (2005) 32 applied Kvaal’s dental age calculation technique on one hundred and ninety panoramic dental radiographs with the age group

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ranged from 19 to 75 years. There was no significant difference between

long cone periapical technique and orthopantomographs when all six teeth were selected to predict the age.

Roberto Cameriere et al (2006) 33 in a study to estimate the age from 33 skeletal remains by using radiograph of canines. This method showed great reliability to estimate the age of old subjects who died over 50 years.

Balwant Rai et al (2006)34 examined panoramic radiographs of 75 healthy children (40 boys and 35 girls) aged between 5-14 years.

Five different age estimation were applied. The result shown that Williams method was

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more accurate followed by Haavikko, Cameriere, Nolla and lastly Demirjian method.

Kagerer et al (2000)35

conducted a study of age estimation using incremental lines of acellular cementum. They used

mineralized, unstained cross-sections of teeth, mostly mandibular central incisors and third molars. The authors

allowed actual chronologic age of an accuracy of within three years. In case of of old age people, periodontium status may get altered due to pathological process.

Sasidhar Singaraju et al (2009)36 conducted a retrospective study using two hundred panoramic radiographs which were collected from V.S Dental College. Maximum tooth length, root length and pulp length, root and pulp width at three levels were calculated on right maxillary canine. The entire samples were divided into three groups and multiple regression models were calculated. There was no significant difference between chronological and estimated age. The observed correlation coefficients were 0.89,0.97 and 0.96.All three groups results were closely related to each other and it was found to be fairly accurate.

Olze et al (2010) 37 analysed eruption stages of third molar in 605

conventional orthopantomographs collected from Canada population aged 11 to 29 years The results obtained shown that time

of alveolar, gingival, and complete eruption of the third molars in the arch could be used for forensic

analysis with minimal variations.

Medha Babshet et al (2010) 38 used Italian formula to estimate the age of Indian population aged between 20-70years by using intraoral periapical digital radiographs of mandibular canines which were taken by using paralleling technique. Mean absolute error was 11.58 years and 10.76 years for Italian and Indian formula respectively. No apparent difference was observed between these two formulas.

Jayaraman et al (2011) 39 validated the applicability of Demirjian’s dataset on a southern Chinese population. A total of 182 dental panoramic tomographs comprising an equal number of boys and girls with an age range from 3 to 16 years were scored. Dental maturity scores were obtained from the Demirjian’s dataset and dental age was calculated. The difference in chronological and estimated dental ages was calculated using the paired t-test. There was a mean overestimation of

calculated dental age of 0.62 years for boys and 0.36 years for girls when compared with chronological age. They concluded that for southern Chinese children Demirjian’s method was not suitable for age estimation. Sudhanshu Saxena et al (2011) 40 conducted a study of ageestimation from canines using radiographs.

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Pulp/root length ratio, pulp/tooth area length ratio, pulp/root width at

three varying levels of root were calculated. The accuracy of estimated age ranged from -2.2 to 1.5 years.

Jagannathan et al (2011)41 analysed the

Volumetric reconstruction of scanned images of mandibular canines of 140 individuals

and evaluated pulp/tooth volume ratio

of mandibular canines for age estimation. While using the Belgian formula for Indian population, the mean absolute errors of 15.34 years, and 8.54 years error was obtained by regression equation which was lower than those derived from former. Hence, they stated that specific formula has to be applied to estimate the age of each population.

Jayanth Kumar et al (2011)42 evaluated the accuracy of French maturity scores and India specific formula with the

help of Demirjian's method.

The study was conducted on 121 archived digital orthopantamographs which were predominantly pre-treatment orthodontic radiographs from patients without any obvious developmental anomalies The radiographs were evaluated as per Demirjian's criteria and age was calculated using the formula developed for the Indian population.The results showed that the mean absolute error for the sample was 1.18 years. The age estimation using this method narrows down the error rate to just over one year making this method reliable. However the inclusion of third molar increases the error rates in the older individuals within the sample. Chandramala et al (2012)43 concluded a study

of age estimation in 100 subjects with

mean age range was 32.25 years for males and 29.08 years for females. They carried out the correlation and regression analysis. Results shown that highest coefficient of determination was obtained for Upper second premolar.

Nithin Agarwal et al (2012)44 conducted a study to assess the chronological age based on morphological variance of maxillary central incisors. Intra oral periapical radiographs were

9


taken using paralleling technique from fifty subjects aged between 20-70 years. Tooth length, pulp length,root length and ratios of root and pulp width at three varying points were measured. Regression formulas were used to predict the age and it was found to be fairly accurate.

Bilge Nur et al (2012) 45 evaluated the applicability of Demirjian and Nolla methods for northeastern Turkish population which was performed on panoramic radiographs of 673 subjects aged 5–15.9 years. The mean dental age (DA) according to the Demirjian and Nolla methods were compared to the mean chronological age (CA). The mean CA of the study sample was 10.37±2.90 and 10.03±2.81 years for females and males, respectively. Using the Demirjian method, the mean estimated DA was 11.26±3.02 years for females and 10.87±2.96 years for males. For Nolla method, the mean estimated DA was 9.80±3.41 and 9.53±3.14 years for females and males, respectively. The mean differences between the CA and DA according to the Demirjian and Nolla methods were 0.86 and -0.54 years for total study sample. Nolla method was found to be a more accurate method for estimating DA in northeastern Turkish population.

Erbudak et al (2012) 46 evaluated

the feasibility of length and width measurements of pulp cavity for age estimation

and examined the correlation between chronological and estimated ages and. 123 digitized panoramic radiographs were collected in which the length and width of six types of teeth were calculated. Linear regression models was done. Estimated ages shown high differences when compared to chronological age. They concluded that difference between

chronological and estimated ages was more than 12 years found on panoramic radiographs in Turkish individuals.

Deepu George Mathew et al (2013)47 conducted a study to develop an independent method to estimate the age of Indian individuals using mandibular posterior teeth in orthopantomographs. Eighty eight subjects were included in the study and test subsets. Adobe photoshop CS5 was used to measure the distance between central fossa to the highest point on the root furcation and another point was the distance between the roof and floor of the pulp chamber. The ratio derived between these two measurements was used to estimate the age.R2 value was fairly good and this procedure was found to be fairly accurate to predict the age.

Djukic K et al (2013) 48 conducted a study that evaluated the accuracy of Demirjian's and Willems' methods for dental age estimation in Serbian children population using panoramic radiographs of 686 children (322 boys and 364 girls) with age range from 4 to 15 years. Both methods showed discrepancy between obtained and chronological age. The Demirjian's method overestimated age with a mean accuracy of 0.45 in boys and 0.42 in girls, while Willems' method showed lower discrepancy (0.12 and 0.16 in boys and girls, respectively). They suggested that Willem's method was more accurate for estimating dental age in contemporary Serbian children population.

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Sarkar S et al (2013) 49 evaluated age in children, adolescents and young adults using Demirjian's 8-Teeth Method in an Indian population and compared the effectiveness of existing Demirjian's formula with that of the Indian formula. Among the 100 samples the mean chronological age in 50 males was 13.44 years and mean chronological age in 50 females was 13.12 years. It was evaluated that the Demirjian's formula underestimated the mean dental age by 1.63 years in males and by 1.54 years in females, whereas a variation of 0.10 years in male and 0.94 years in female was found with the Indian formula. The mean dental age obtained using Indian formula was approximating with the chronological age in the male and female by a margin of 0.94 years. They concluded that Acharya's Indian formula was more effective in evaluating the dental age closer to the chronological age of an individual in an Indian population in comparison with the existing Demirjian's formula.

Ambarkova et al (2013)50 analyzed panoramic radiographs of 966 children (485 female and 481 male, aged 6–13 years) treated at the University and Community Dental Clinics in Skopje using four Demirjian methods and a Willems method for determining dental ages. Intra-rater and interrater agreement of mineralization stages were 0.86 and 0.82, respectively. All methods significantly overestimated dental age when compared to the chronological age (p > 0.001).

Limdiwala et al (2013)51 conducted a study using one hundred orthopantomographs with Kvaal's criteria (Group A) and 50 orthopantomographs without Kvaal's criteria (Group B) were included. On the basis of Kvaal's criteria, the difference between chronological age and real age was 8.3 years. This suggests that the accuracy of this method depends on the precision of measurements and quality and number of the orthopantomographs. Mahkameh Moshfeghi et al (2014)52 conducted a study using 112 panoramic radiographs of Iranian patients, to measure the amount of secondary dentin deposition o find out the age of individuals. Patients aged between 20-70 years were included in the study. Then the population was divided into two groups, study and test group respectively.



Ratios of




11



pulp/root length, pulp/tooth length and pulp width /root width at three

levels

in lateral incisor, canine and first premolar of mandible were calculated using Photoshop 2007.They conducted that strong correlation coefficient was obtained in canine parameters to predict the age.

Caroline Edward Ayad (2014)53 examined 99 Orthopantomgraphs (OPG) to determine its usefulness of Orthopantomgraphs (OPGs) in the assessment of the Sudanese adult age compared to chronological age. The pulp root length ,root length, pulp/root ratio , total tooth length ,crown length of the mandibular canine were measured in mm and the estimated age was recorded using the mandibular canine measurements .Patients were classified into three groups ,A was of age >20 years old ,B was of 20 to 27 and C was of age <27. The estimated age in A and C groups were well correlated with the chronological age in both genders and no significant difference was detected, but in B group there is a significant difference between the estimated and chronological age and between males and females measurements. Mostafa M Afify et al (2014) 54 assessed the applicability of pulp tooth ratio of mandibular canine, first and second premolars in orthopantomographs to estimate the age of an individual. Total of 500 radiographs were included in the study, aged between 18 to 71 years. Regression equation was closely correlated with age and standard errors of estimate was ranged between 4.10 to 5.66 years. So, pulp-tooth ratio method was useful to estimate the age of individuals.

Aída C. Medina et al (2014) 55 examined panoramic radiographs of 238 Venezuelan children aged 5-13 years for assessment of dental age using the methods described by Demirjian and Willem. For the Demirjian method, the mean difference between dental age and chronological age was 0.62 ± 0.93 years, statistically significant. The mean overestimation was lower for females than for males (females 0.56 ± 0.96 years, males 0.67 ± 0.93 years). For the Willems method, the mean difference between dental age and

chronological age was 0.15 ± 0.97 years, not statistically significant. Accuracy was significantly different between genders, performing best for females (females 0.01± 0.96 years, males 0.29± 0.96 years). The Willems method for age estimation was found to be more accurate than the Demirjian method in this sample of Venezuelan children. Ioannis N.Tsatsoulis et al (2014)56 investigated the effects of age and external irritating stimuli on the thickness and morphology of pulp chamber floor and ceiling in mandibular molars. A total of 234 panoramic radiographs were obtained from School of Dentistry, University of Athens. They calculated pulp chambers ceiling /crown height and pulp chamber floor/crown height in relation to age and angle of pulp chamber ceiling and floor in relation to age. There was significant difference in the location of secondary dentin formation between the two pulp chamber walls. They concluded that increase in the rate of the pulp chamber ceiling thickness is similar to that of the pulp

12


chamber floor thickness. Age is related to diminished pulp chamber size. They stated that the external stimuli also have an effect on the pulp chamber dimensional changes.

Manjushree Juneja et al (2014) 57 conducted a study using panoramic radiographs to estimate the age of 200 population with the age group of 18-72 years.


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Radiographic images of maxillary canines (RIC) were processed using a computer –aided drafting program. Following variables were recorded namely, pulp/root length, pulp/tooth length, pulp/root width at enamel-cementum junction level, pulp/root width at mid-root level, pulp/root width at

mid-point level between CEJ level and mid-root level and pulp/tooth area ratio.Among

these variables, the mid-root level and pulp/tooth area ratio showed strong correlation coefficient and the estimated error was 3.012 years. They concluded that there was significant correlation between age and morphological variables of canine.

Rezwana Begum Mohammed et al (2014)58 evaluated the

possible correlation between DA and CA using Willems method in South Indian population. 332 Digital Orthopantomogram was assessed mandibular teeth on left side from central incisor to the second molar.

The present study showed a significant correlation between DA and CA in both males and females. The overall mean difference for males was 0.69 ± 2.14 years while for females, it was 0.08 ± 1.34 years . Willems method underestimated the mean age of 0.69 years for boys and 0.08 years for females and showed that females mature earlier than males in selected population.

Jurca et al (2014) 59 conducted on X-rays of 285 children aged between 6-13 years. Dental age was determined based on the degree of mineralisation of the seven left mandibular teeth, and t-tests were used to assess the difference between dental age and chronological age within each age category. Dental age was more advanced in girls in almost all age groups, whereas in boys just the 6-7 and 8-9 age groups presented a more advanced dental age. The results of the study showed that Demirjian’s method has some limitations for a Romanian population, and that these standards are applicable only in certain age groups.

13


Patil et al (2014) 60 evaluated the accuracy of Kvaal’s age estimation formula. 100 subjects between the age group 20 and 50 years digitized intraoral periapical (IOPA) radiograph of maxillary central incisors was taken and length and width of the teeth were measured and their ratios were calculated and applied to Kvaal and coauthors formula. The estimated age and chronological age were compared, less accurate results were found in sample Indian population. Modified Kvaal’s formula was then developed by using regression analysis of the ratios and to evaluate the accuracy of this formula, the study was repeated using same criteria and methodology on another subjects (101-200).Using Kvaal’s formula standard error of estimated age was more in sample Indian population when compared with Norwegian population.

This study concluded that formula derived from Norwegian population was

not applicable to sample Indian population.

Javadinejad et al (2015)61 conducted a study to compare the accuracy of four radiographic age estimation methods. Orthopantomographic images of 537 healthy children (age: 3.9-14.5 years old) were evaluated. Dental age of the subjects was determined through Demirjian’s, Willem’s, Cameriere’s, and Smith’s methods. The mean chronological age of the subjects was 8.93 ± 2.04 years. Overestimations of age were observed follow-ing the use of Demirjian’s method (0.87 ± 1.00 years), Willem’s method (0.36 ± 0.87 years), and Smith’s method (0.06 ± 0.63 years). However, Cameriere’s method underestimated age by 0.19 ± 0.86 years. While paired t-tests revealed significant differences between the mean chronological age and ages determined by Demirjian’s, Willem’s, and Cameriere’s methods (P > 0.001), such a significant difference was absent between chronological age and dental age based on Smith’s method (P = 0.079). Pearson’s correlation analysis suggested linear correlations between chronological age and dental age determined by all four methods.

Kiran et al (2015)62 conducted a study to evaluate the applicability of Demirjian method and its comparison with Indian formulas for estimation of dental age in subjects attending a dental school in South India. A total of 250 individuals (130 males and 120 females) between 7 and 18 years, with orthopantamographs were included in the study. Dental age was estimated using Demirjian’s and Indian formulas. The mean chronological age of the study sample was 12.39 ± 3.32 years; while the mean age obtained from Demirjian’s method and Indian‑specific regression formula were 11.56 ± 3.17 years and 14.20 ± 3.24 years, respectively. In the present study, the Demirjian’s method under estimated dental age by 0.84

years in males and 0.83 years in females (P > 0.05). Indian‑specific regression formulas overestimated dental age by 1.72 years in males and 1.91 years in females (P > 0.05).

Ekta Priya et al (2015) 63 conducted a pilot study to test the applicability of Willem’s method of dental age assessment at the threshold of 14 years considering prohibition of employment of children. The sample consisted of 30 males and 30 females. The dental age estimation was performed by two blinded examiners using Willem’s method. It was seen that there was underestimation of age in both males and females. The difference in females and males were

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-0.29 years and -0.23 years respectively. The scores of dental maturation described by Willems may be suitable for South Indian children.

Gupta S et al (2015)64

annalysed 70 dental radiographs of orthodontic patients with age ranges from 9-16 years. Age estimation was done by both Demirjian's and Willems method using panoramic radiographs. Skeletal maturity was estimated using lateral cephalographs. When

compared with Demirjian's stage for mandibular left second molar.

and

they concluded that Willems method seems to be more appropriate in estimating

age among Indian males, and Demirjian's method for Indian

females.

Lee SS et al (2011) 65 evaluated validity of Demirjian's and the modified methods in Korean juveniles and adolescents using 1483 digital orthopantomograms which consist of 754 males and 729 females in the age range of 3-16 years were collected. New age estimation method based on Korean population data was calculated. Willems' method was found to be most accurate followed by new Korean method with slight difference for Korean population for both sexes and concluded that both Willems' method and new Korean method conducted by present study were proven to be suitable for Korean population.

Uday Ginjupally et al (2015)66 designed a study to estimate the age of 200 intra oral periapical radiographs of maxillary incisors. Pulp cavity width is measured at cervical and middle third of maxillary incisors using digital Vernier caliper. Regression formulas were derived for males and 0.21 years in females. Hence, there was difference between male and female regarding age prediction.

El Morsi DA et al (2015)67 conducted a study to estimate the age from tooth coronal index of mandibular premolars and molars of both sides using panoramic radiographs of known age. Study included 234 Egyptian subjects of known age. The length of tooth crown and that of coronal pulp cavity were measured in 845 mandibular premolars and 835 mandibular molars.TCI for premolars was larger than those of molars and it was higher in males than females. It was concluded that there was highest significant correlation of the second right premolar TCI with age.

Indira AP et al (2015)68 conducted a study using 100 intra oral periapical radiographs of both genders aged between 16 and 50 years. The tooth selected for the study was left maxillary central incisor. The ratio between total pulp length and cervical pulp width was calculated. There was negative correlation between the age and the variable. Hence, this study estimated the nearest chronological age of an individual.

15


Ranjdar M.Talabani et al(2015)69 analysed permanent mandibular first molar on digital panoramic radiographs of sulaimani population. This study included 96 individuals who were divided into four groups. The height of coronal pulp cavity and the height of crown of first molars from all subjects were measured and a regression equation was calculated. There was a strong negative linear relationship between morphology of mandibular first molars with chronological age. So, they concluded that study showed a good degree of accuracy in predicting age.

Smrithi D Veera et al (2015)70 conducted a study using 100panoramic radiographs and the subjects aged between 20-60 years. Mandibular permanent second premolar and first molar tooth coronal index was measured. Regression equation was created. There was no difference between estimated and chronological age for both second premolar and molar configurations.

Nerella Narendra Kumar et al (2016)71 estimated the age of Davangere population by measuring the pulp tooth area ratio using digitized intaoral periapical radiographs of permanent mandibular second molar. Study subjects aged between 14-60 years of both genders. The standard error of estimate was 12 years which wasn’t in the acceptable range. MATERIALS AND METHODS SOURCE OF DATA The present study was conducted in K.S.R Institute of Dental Science and Research, Tiruchengode. Those who referred to the oral medicine and radiology department for the purpose to undergo orthodontic treatment, will be selected randomly for the study were taken up for the study. Orthopantmographs taken for orthodontic treatment purpose were retrived from the data and One Intra oral periapical radiograph were taken for the same patient for this study purpose. INCLUSION CRITERIA • Above the age of 8 years • Only fully erupted mandibular first molar in normal functional occlusion • Those who give voluntary consent for the study procedure • Absence of systemic diseases, dental anomalies, nutritional and endocrine problems, premature birth, and birth defect EXCLUSION CRITERIA • Teeth with radio-opaque fillings • Crowns/prosthesis • Any associated pathologies • Malalignment, rotation • Impacted teeth • Teeth with developmental anomalies • Attrited teeth

MATERIALS USED: WILLEMS METHOD: Digital Panoramic System:SIRONA-ORTHOPHOS XG Computer : Acer 15.6”HD LED LCD Image Editing Software ; Adobe Photoshop CS-6 KVAAL’S METHOD: Dental Radiograph Machine : Confident Dental Equipments Dental Intra Oral Xray film : Carestream Dental E-speed size 2 Fim holder : Dentsply Rinn holder Automated processor unit : Velprex Extra-X Dryer Tracing sheet Apsara plantinum pencil Magnifying glass Divider Measuring scale

METHODOLOGY Patients who referred to the oral medicine and radiology department for the purpose to undergo orthodontic treatment were selected randomly for the study. Informed consent was obtained prior to the investigatory procedure. Orthopantmographs was taken for orthodontic treatment purpose and One Intra oral periapical radiograph in relation to right mandibular first molar by using paralleling cone technique were taken for the same patient for this study purpose. The study sample consisted of 75 randomly selected subjects ( males and females) of age ranging from 8 to years divided into five groups according to age. Clinical

16


examination of all 75 individuals was performed and name, sex, and date of birth of each individual and date of radiography were recorded.

Chronological age of a subject was calculated

from the date on which the radiographs were exposed

by subtracting the birth date for that particular individual. The dental age was determined using orthopantamographs by Willem’s method and using Intra oral periapical radiograph by Kvaal’s method.

Willem’s method : The panoramic images were obtained in the Digital Imaging and Communication in Medicine (DICOM) format, were saved as DICOM files on a computer and were analysed by using the Adobe Photoshop CS6 image editing program. With the help of Photoshop generator, the images were enlarged and adjusted with the brightness/contrast, if needed. The obtained panoramic images were used to assess the status of maturation on the basis of calcification of the permanent teeth in mandibular right side, from central incisor to the second molar, using Demirjian et al., method(Table 1).After noting all stages of teeth from central incisor to the second molar, the developmental status of a particular tooth was calculated in years on the basis of tables given by Willems et al,.(Table 2). All the values from central incisor to the second molar thus obtained were summed to obtain an overall maturity score, which will indicate the DA of that particular patient. Kvaal’s method : Intra-oral periapical radiographs of right mandibular first molar were taken by using paralleling cone technique. The exposed films were developed in automatic processor in fresh solutions. The developed X-ray films were dried and subsequently coded. Intra oral periapical radiographs are traced on tracing sheet. On the radiographs obtained, 15 standardized points were marked, on the basis of the original method for dental age calculation published by Kvaal et al., and measurements were taken using divider and scale with millimeter calibrations. • Tooth length (T) • Pulp length (P) • Root length (R) • Ratio of Pulp width to Root width • A: Cemento-Enamel Junction • B: Midpoint between A and C • C: Midroot level The ratios calculated were: P - Pulp length/root length R - Pulp length/tooth length. Ratios of the pulp/root width at three different levels: At the ECJ (A) At the midpoint between ECJ and mid root level (B) At the mid root level (C)

The obtained values were applied to the formula developed to estimate the age from right mandibular first molar given by Kvaal and coauthors.

Age = 33.5 – 18.6 (M) – 3.49 (W − L) M = P+R+A+B+C5 W =B+C2 L= P+R2 W =

Mean value of width ratios from level B and C L = Mean value of length ratios

P and R W − L = Differences between W and L

The estimated age was compared with the chronological age recorded and the efficacy of the formula in estimating the age was evaluated.

Table I :Description for developmental stages of tooth

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STAGES DESCRIPTION A

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A begining of calcification is seen at the superior level of crypt in the form of cones. There is no fusion of these calcified points. B Fusion of the calcified points forms one or more cusps, giving a regularly outlined occlusal surface C Enamel

and dentin


formation is complete at the occlusal surface and converge at cervical region. Dentin deposition is seen. The outline of the pulp chamber has a curved shaped at the occlusal border. D Crown formation is completed down to the cementoenamel junction. Superior border of pulp chamber in uniradicular teeth has a definite curved form; projection of pulp horns gives an umbrella top. In molars, pulp chamber has a trapezoidal form. Begining of root formation is seen in the form of a spicule E Uniradicular teeth The walls of pulp chamber form straight lines, whose continuity is broken by the pulp horn. The root length is less than the crown height. In Molars Initiation of radicular bifurcation is seen as a calcified point or a semi-lunar shape. Root length is less than crown height. F Uniradicular teeth The walls of pulp chamber form isosceles triangle. Apex ends in a funnel shaped. The root length is equal

to


or greater than the crown height. In molars The bifurcation has developed down to give the roots a distant outline with funnel shaped endings. Root length is equal to or greater than crown height. G The walls of root canal are now parallel and its apical end is partially open(distal root in molars) H The apical end of the root canal is

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completely closed. Periodontal membrane has a uniform width around the root

and apex.

Table 2 : Developmental status of a particular tooth by Willems et al., GENDER TOOTH A B C D E F G H Boys Central Incisor - - 1.68 1.49 1.5 1.86 2.07 2.19

Lateral Incisor - - 0.55 0.63 0.74 1.08 1.32 1.64

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Canine - - - 0.04 0.31 0.47 1.09 1.9

First Bicuspid 0.15 0.56 0.75 1.11 1.48 2.03 2.43 2.83

Second Bicuspid 0.08 0.05 0.12 0.27 0.33 0.45 0.4 1.15

First Molar - - - 0.69 1.14 1.6 1.95 2.15

Second Molar 0.18 0.48 0.71 0.8 1.31 2 2.48 4.17 Girls Central Incisor - - 1.83 2.19 2.34 2.82 3.19 3.14

Lateral Incisor - - - 0.29 0.32 0.49 0.79 0.7

Canine - - 0.6 0.54 0.62 1.08 1.72 2

First Bicuspid -0.95 -0.15 0.16 0.41 0.6 1.27 1.58 2.19

Second Bicuspid -0.19 0.01 0.27 0.17 0.35 0.35 0.55 1.51

First Molar - - - 0.62 0.9 1.56 1.82 2.21

Second Molar 0.14 0.11 0.21 0.32 0.66 1.28 2.09 4.04

Figure 1-Digital Panoramic System : SIRONA-ORTHOPHOS X G

Figure 2 – Dental Radiograph Machine – Carestream Dental

Figure 3 – Dental Intra Oral Xray Film

Figure 4 – Dentsply Rinn Holder

Figure 5 – Automatic Processor

Figure 6 Armamentarium for Tracing Radiograph

Figure 7-Tooth Length

Figure 8 – Pulp Length

Figure 9 – Root Length

Figure 10 – Width of the Pulp At Cemento-enamel Junction

STATISTICAL ANALYSIS The data obtained from the study was entered in Microsoft Excel and was given for statistical analysis. The data was analysed using Statistical Package for Social Sciences(SPSS) software version 16.0(Windows version 17.0 SPSS Inc.,Chicago,IL,USA).The level of significance (α) was fixed at 5% (p≤0.05). PAIRED t TEST : Student’s t test was used to analyze the significance between the two different age estimation methods. Paired t test is applied when there is a pair of data from single element in an observation .Data are collected by two different methods for a same person, so that the same group participated in both the

19


methods. Then the mean of both the groups are compared to get the t value. Descriptive analysis The study comprises of 24 males and 51 females of age ranging from 7-32 years. The subjects were divided into five groups ,where 7 males and 8 females of age ranging from 27-32 years were in group I, 7 males and 8 females of age ranging from 22-26 years were in group II, 5 males and 10 females of age ranging from 17-21 years were in group III, 2 males and 13 females of age ranging from 12-16 years were in group IV ,3 males and 12 females of age ranging from 7-11 years were in group V. Each group comprises of 15 subjects.

Table III : Distribution of the subjects by their age and gender Group Age ranges Male Female Total

No. % No. % I 27-32 years 7 47 8 53 15 II 22-26 years 7 47 8 53 15 III 17-21 years 5 33 10 66.7 15 IV 12-16 years 2 13 13 86.7 15 V 7-11 years 3 20 12 80 15

Table IV : ILLUSTRATING THE RESULTS OBTAINED FROM KVAAL’S METHOD (GROUP 1) S.No GENDER CA P R M W L KVAAL METHOD DA 1

Female 27 1.22 0.74 0.73 0.7 1.64 16.6 2

Male 30 1.05 0.73 0.71 0.6 0.89 19.1 3 Female 28 1.17 0.81 0.76 0.7 1.02 18.2 4 Male 28 1.23 0.81 0.76 0.7 1.02 18.2 5 Male 29 1.05 0.78 0.70 0.6 0.91 19.32 6 Female 29 1.15 0.76 0.62 0.45 0.95 20.22 7 Male 29 1.11 0.82 0.69 0.5 0.96 19.2 8 Female 29 1.12 0.76 0.71 0.5 0.97 18.9 9 Female 27 1.17 0.76 0.74 0.6 0.97 18.46 10 Female 31 1.07 0.73 0.74 0.7 0.9 19.04 11 Female 27 1.05 0.73 0.72 0.6 0.89 19.17 12 Male 28 1.23 0.81 0.76 0.7 1.02 18.2 13 Female 26 1.12 0.76 0.71 0.5 0.97 18.9 14

Male 27 1.05 0.78 0.70 0.6 0.9 19.32 15

Male 29 1.05 0.73 0.71 0.6 0.8 19.17

P - Pulp length/root length; R - Pulp length/tooth length; M – mean value of all length and width; W -

Mean value of width ratios from level B and C;L -Mean value of length ratios

P and R Table V: ILLUSTRATING THE RESULTS OBTAINED FROM KVAAL’S METHOD (GROUP 2) S.No GENDER CA P/L R/L M W L KVAAL METHOD DA 1

Female 20 1.4 0.76 0.77 0.6 1.08 20.85 2

Female 20 1.13 0.68 1.45 0.4 1.95 11.08 3 Female 20 1.14 0.64 1.32 0.55 1.9 13.71 4 Female 20 1.07 0.65 0.64 0.5 0.86 22.9 5 Male 20 1.12 0.69 0.7 0.61 0.91 21.5 6 Female 19 0.88 0.66 0.6 0.55 0.77 22.7 7 Female 21 1.21 0.63 0.71 0.65 0.92 21.24 8 Female 23 1.15 0.75 0.73 0.61 0.95 21.11 9 Male 21 1.13 0.77 0.69 0.55 0.95 22.09 10 Male 22 1.18 0.8 0.7 0.5 0.99 22.2 11 Male 22 1.14 0.77 0.7 0.77 0.95 18.37 12 Male 22 1.28 0.09 0.63 0.7 0.69 21.79 13 Male 22 1.14 0.8 0.66 0.5 0.97 19.6 14 Female 22 1.16 0.82 0.72 0.5 0.99 18.47 15

Male 21 1.16 0.77 0.71 0.6 0.97 19.09

20




P and R Table VI : ILLUSTRATING THE RESULTS OBTAINED FROM KVAAL’S METHOD (GROUP 3) S.No GENDER CA P/L R/L M W L KVAAL METHOD DA 1

Male 18 1.125 0.66 0.75 0.68 0.9 20.31 2 Female 18 1.14 0.63 0.66 0.62 0.88 22 3 Female 20 1.13 0.652 0.68 0.62 0.9 21.63 4 Male 20 1.14 0.8 0.66 0.5 0.97 19.6 5 Female 19 1.13 0.68 0.7 0.6 0.91 21.52 6 Female 20 1.15 0.75 0.56 0.35 0.95 25.17 7 Female 20 1.13 0.77 1.22 0.6 1.65 14.47 8 Female 21 1.125 0.66 0.75 0.68 0.9 20.31 9 Female 21 1.23 0.89 0.78 0.65 1.06 17.5 10 Female 21 1.33 0.8 0.84 0.75 1.06 16.79 11 Male 19 1.26 0.78 0.71 0.5 1.02 18.5 12 Female 17 1.23 0.89 0.78 0.65 1.06 17.5 13 Female 18 1.24 0.66 0.8 0.75 0.95 17.92 14

Male 17 1.09 0.75 0.72 0.65 0.92 19.16 15

Male 16 0.11 0.09 0.32 0.5 0.1 26.15



P and R Table VII: ILLUSTRATING THE RESULTS OBTAINED FROM KVAAL’S METHOD (GROUP 4) S.No GENDER CA P/L R/L M W L KVAAL METHOD DA 1

Female 14 1.23 0.76 1.34 0.65 1 9.82 2 Female 14 1.06 0.65 1.48 0.7 1.95 10.36 3 Female 15 1.14 0.63 0.77 0.74 0.8 9.76 4 Female 14 1.07 0.74 0.74 0.65 0.9 18.86 5 Female 13 1.07 0.74 0.74 0.65 0.9 18.86 6 Male 16 0.63 0.44 0.57 0.65 0.53 22.48 7 Female 13 1.07 0.74 0.74 0.65 0.9 18.86 8 Female 16 1.21 0.77 0.7 0.6 0.99 19.6 9 Female 16 1.13 0.82 0.69 0.5 0.98 18.9 10 Female 14 1.18 0.75 0.76 0.7 0.97 18.42 11 Female 16 1.21 0.77 0.7 0.6 0.99 19.6 12 Female 16 1.13 0.82 0.69 0.5 0.98 18.9 13 Female 13 1.07 0.74 0.74 0.65 0.9 18.86 14

Male 18 0.63 0.44 0.57 0.65 0.53 22.48 15 Female 15 1.21 0.77 0.7 0.6 0.99 19.6



P and R Table VIII: ILLUSTRATING THE RESULTS OBTAINED FROM KVAAL’S METHOD (GROUP 5) S.No GENDER CA P/L R/L M W L KVAAL METHOD DA 1

Female 8 1.21 0.85 0.87 0.8 1.03 16.51 2

Male 8 1.22 0.78 0.86 0.85 1 16.98 3 Female 8 1.12 0.7 0.7 0.5 0.9 19.04 4 Female 10 1.09 1.09 0.8 0.6 1.09 16.9 5 Female 10 1.11 0.73 0.76 0.7 0.9 18.59 6 Female 10 1.28 0.86

21


0.8 -.75 1.07 17.5 7 Female 9 1.18 0.78 0.73 0.6 098 18.56 8 Female 8 1.13 0.78 0.88 0.8 0.95 16.6 9 Female 9 1.08 0.77 0.73 0.6 0.92 18.9 10 Male 9 1.12 0.75 0.81 0.7 0.93 17.63 11 Female 9 1.03 0.68 0.7 0.6 0.85 19.78 12 Female 10 1.09 0.81 0.74 0.5 0.95 5.97 13 Female 11 1.15 0.73 0.77 0.7 0.94 18.9 14 Female 10 1.14 0.87 0.8 0.75 1.01 17.74 15

Male 10 1.16 0.86 0.84 0.7 1.01 16.79



P and R TABLE IX: DEVELOPMENTAL STAGES OF EACH OF THE RIGHT MANDIBULAR TEETH FOR GROUP I

S.No. GENDER CA 41 42 43 44 45 46 47 1 Female 27 H H H H H H H 2 Male 30 H H H H H H H 3 Female 28 H H H H H H H 4 Male 28 H H H H H H H 5 Male 29 H H H H H H H 6 Female 29 H H H H H H H 7 Male 29 H H H H H H H 8 Female 29 H H H H H H H 9 Female 27 H H H H H H H 10 Female 31 H H H H H H H 11 Female 27 H H H H H H H 12 Male 28 H H H H H H H 13 Female 26 H H H H H H H 14 Male 27 H H H H H H H 15 Male 29 H H H H H H H

TABLE X: DEVELOPMENTAL STAGES OF EACH OF THE RIGHT MANDIBULAR TEETH FOR GROUP II S.No. GENDER CA 41 42 43 44 45 46 47 1 Female 20 H H H H H H H 2 Female 20 H H F H G H F 3 Female 20 H H H H G G H 4 Female 20 H H H H G H F 5 Male 20 H H G G F H G 6 Female 19 H H G H H H G 7 Female 21 H H H H H H H 8 Female 23 H H G F G H G 9 Male 21 H H H H H H H 10 Male 22 H H H H H H H 11 Female 21 H H H H H H H 12 Female 22 H H H H H H H 13 Male 22 H H H H H H H

14 Female 22 H H H H H H H 15 Male 22 H H H H H H H

TABLE XI: DEVELOPMENTAL STAGES OF EACH OF THE RIGHT MANDIBULAR TEETH FOR GROUP III

S.No. GENDER CA 41 42 43 44 45 46 47 1 Female 14 H H G F F H E 2 Female 14 H H G G G H G 3 Female 15 H H G E F H F 4 Female 14 H H F H G H F 5 Female 13 H H G G G H G 6 Male 16 H H H H G H G 7 Female 13 H H G G G H G 8 Female 16 H H F H G H E 9 Female 16 H H G H G H H 10 Female 14 H H G G G H G 11 Female 16 H H F H G H E 12 Female 16 H H G H G H H 13 Female 13 H H F H G H F 14 Male 16 H H H H G H G 15 Female 16 H H F H G H E

TABLE XII: DEVELOPMENTAL STAGES OF EACH OF THE RIGHT MANDIBULAR TEETH FOR GROUP IV S.No. GENDER CA 41 42 43 44 45 46 47 1 Female 14 H H G F F H E 2 Female 14 H H G G G H F 3 Female 15 H H G E F H F 4 Female 14 H H G F G H F 5 Female 13 H H G G F H F 6 Male 16 H H G H G H G 7 Female 13 H H G G F H G 8 Female 16 H H F H F H G 9 Female 16 H H G H F H H 10 Female 14 H H G G F H G 11 Female 16 H H F H F H G 12 Female 16 H H G H F H H 13 Female 13 H H F F F H F 14 Male 16 H H G H G H G 15 Female 16 H H F H F H G

22


TABLE XIII: DEVELOPMENTAL STAGES OF EACH OF THE RIGHT MANDIBULAR TEETH FOR GROUP V S.No. GENDER CA 41 42 43 44 45 46 47 1 Female 8 F G E D D F B 2 Male 8 F F E D D H D 3 Female 8 G F D D D G C 4 Female 10 G F F E F H C 5 Female 10 G G E D D F B 6 Female 10 F E E D D G D 7 Female 9 E E E E D G B 8 Female 8 F F E D D G C 9 Female 9 G G E D D G C 10 Male 10 G G D D D G C 11 Male 9 G G D D D G C 12 Female 9 G G E F F H E 13 Female 11 H H E F F G G

14 Female 10 E H E E F G G 15 Male 10 E H E F F F G

Table XIV: ILLUSTRATING THE RESULTS OBTAINED FROM WILLEM’S METHOD (GROUP 1)

S.No. GENDER CA 41 42 43 44 45 46 47 Willems method 1

Female 27 3.14 0.7 2 2.19 1.51 2.21 4.04 15.79 2

Male 30 2.19 1.64 1.9 2.83 1.15 2.15 4.17 16.03 3 Female 28 3.14 0.7 2 2.19 1.51 2.21 4.04 15.79 4 Male 28 2.19 1.64 1.9 2.83 1.15 2.15 4.17 16.03 5 Male 29 2.19 1.64 1.9 2.83 1.15 2.15 4.17 16.03 6 Female 29 3.14 0.7 2 2.19 1.51 2.21 4.04 15.79 7 Male 29 2.19 1.64 1.9 2.83 1.15 2.15 4.17 16.03 8 Female 29 3.14 0.7 2 2.19 1.51 2.21 4.04 15.79 9 Female 27 3.14 0.7 2 2.19 1.51 2.21 4.04 15.79 10 Female 31 3.14 0.7 2 2.19 1.51 2.21 4.04 15.79 11 Female 27 3.14 0.7 2 2.19 1.51 2.21 4.04 15.79 12 Male 28 2.19 1.64 1.9 2.83 1.15 2.15 4.17 16.03 13 Female 26 3.14 0.7 2 2.19 1.51 2.21 4.04 15.79 14

Male 27 2.19 1.64 1.9 2.83 1.15 2.15 4.17 16.03 15

Male 29 2.19 1.64 1.9 2.83 1.15 2.15 4.17 16.03

Table XV: ILLUSTRATING THE RESULTS OBTAINED FROM WILLEM’S METHOD (GROUP 2)

S.No. GENDER CA 41 42 43 44 45 46 47 Willems method 1

Female 20 3.14 0.7 2 2.19 1.51 2.21 4.04 15.79 2 Female 20 3.14 0.7 1.08 2.19 0.55 2.21 1.28 11.15 3 Female 20 3.14 0.79 2 2.19 0.55 1.82 4.04 14.53 4 Female 20 3.14 0.7 2 2.19 0.55 2.21 1.28 12.07 5 Male 20 3.14 0.7 1.72 1.58 0.35 2.21 2.09 11.79 6 Female 19 3.14 0.7 1.72 2.19 1.51 2.21 2.09 13.56 7 Female 21 3.14 0.7 2 2.19 1.51 2.21 4.04 15.79 8 Female 23 3.14 0.7 0.49 2 0.55 2.21 1.28 10.37 9 Male 21 2.19 1.64 1.9 2.83 1.15 2.15 4.17 35.74 10 Male 22 2.19 1.64 1.9 2.83 1.15 2.15 4.17 16.03 11 Female 21 3.14 0.7 2 2.19 1.51 2.21 4.04 15.79 12 Female 22 3.14 0.7 2 2.19 1.51 2.21 4.04 15.79 13 Male 22 2.19 1.64 1.9 2.83 1.15 2.15 4.17

16.03 14 Female 22 3.14 0.7 2 2.19 1.51 2.21 4.04 15.79 15

Male 22 2.19 1.64 1.9 2.83 1.15 2.15 4.17 16.03

Table XVI: ILLUSTRATING THE RESULTS OBTAINED FROM WILLEM’S METHOD (GROUP 3) S.No. GENDER CA 41 42 43 44 45 46 47 Willems method 1

Male 18 2.19 1.64 1.9 2.83 1.15 2.15 2.48 14.34 2 Female 18 3.14 0.7 1.72 2.19 0.55 2.21 2.09 12.67 3 Male 20 3.14 0.7 1.72 2.19 1.51 2.21 1.28 12.75 4 Male 20 2.19 1.64 1.9 2.43 1.15 2.15

23


2.48 13.94 5 Female 19 3.14 0.7 2 1.58 1.51 2.21 4.04 15.18 6 Female 20 3.14 0.7 1.72 2.19 0.55 2.21 2.09 12.6 7 Female 20 3.14 0.7 2 2.19 0.55 2.21 2.09 12.88 8 Female 18 3.14 0.7 1.72 2.19 0.55 2.21 2.09 12.67 9 Female 21 3.14 0.7 1.72 2 1.15 2.21 1.28 12.2 10 Female 21 3.14 0.7 1.08 2.19 0.55 2.21 2.09 11.27 11 Male 19 2.19 1.64 1.09 2.83 0.4 2.15 4.17 14.47 12 Female 17 3.14 0.7 1.72 2.19 0.55 2.21 4.04 13.56 13 Female 18 3.14 0.7 2 2.19 1.51 2.21 2.09 13.84 14 Female 17 3.14 0.7 2 2.19 1.51 2.21 4.04 15.77 15

Male 16 2.19 1.64 1.9 2.83 1.15 2.15 4.17 16.03

Table XVII: ILLUSTRATING THE RESULTS OBTAINED FROM WILLEM’S METHOD (GROUP 4) S.No. GENDER CA 41 42 43 44 45 46 47 Willems method 1

Female 14 3.14 0.7 1.72 1.27 0.35 2.21 0.66 10.05 2 Female 14 3.14 0.7 1.72 1.58 0.5 1.51 1.82 11.23 3 Female 15 3.19 0.79 1.72 0.6 0.35 2.21 1.28 10.14 4 Female 14 3.14 0.7 0.49 2 0.55 2.21 1.28 10.37 5 Female 13 3.14 0.7 1.72 1.58 0.55 2.21 1.82 11.72 6 Male 16 2.19 1.64 1.9 2.83 0.4 2.15 2.48 13.59 7 Female 13 3.19 0.79 1.72 1.58 0.55 2.21 2.09 10.93 8 Female 16 3.14 0.7 1.08 2.19 0.55 2.21 0.09 12.16 9 Female 16 3.14 0.7 1.72 2.19 0.55 2.21 4.04 14.55 10 Female 14 3.19 0.79 1.72 1.58 0.55 2.21 2.09 12.43 11 Female 16 3.14 0.7 1.08 2.19 0.55 2.21 0.09 12.16 12 Female 16 3.14 0.7 1.72 2.19 0.55 2.21 4.04 14.55 13 Female 13 3.14 0.7 0.49 2 0.55 2.21 1.28 10.37 14

Male 16 2.19 1.64 1.9 2.83 0.4 2.15 2.48 13.59 15 Female 16 3.14 0.7 1.08 2.19 0.55 2.21 0.09 12.16

Table XVIII: ILLUSTRATING THE RESULTS OBTAINED FROM WILLEM’S METHOD (GROUP 5) S.No. GENDER CA 41 42 43 44 45 46 47 Willems method 1

Female 8 2.82 0.79 0.62 0.41 0.27 1.56 0.11 6.58 2

Male 8 1.86 1.08 0.31 1.11 0.27 2.15 0.8 7.58 3 Female 8 3.19 0.49 0.54 0.41 0.27 0.62 0.21 7.43 4 Female 10 3.19 0.49 1.08 0.6 0.35 2.21 0.32 8.24 5 Female 10 3.19 0.79 0.62 0.41 0.27 1.56 0.11 6.95 6 Female 10 2.82 2.49 0.62 0.41 0.27 1.82 0.32 6.75 7 Female 9 2.34 0.32 0.62 0.16 0.27 1.82 0.11 5.64 8 Female 8 2.82 0.49 0.62 0.41 0.17 1.82 0.21 5.34 9 Female 9 3.14 0.79 0.62 0.41 0.17 1.82 0.21 7.16 10 Male 10 2.07 1.32 0.04 1.11 0.27 1.95 0.71 7.47 11 Male 9 2.07 1.32 0.04 1.11 0.27 1.95 0.71 7.47 12 Female 9 3.19 0.79 0.62 1.27 0.36 2.21 0.66 9.09 13 Female 11 2.19 0.7 0.62 1.27 0.35 1.82 2.09

9.04 14 Female 10 2.34 0.7 0.62 0.6 0.35 1.82 2.09 8.52 15

Male 10 1.5 1.64 0.31 2.03 0.45 1.6 2.48 10.08

Table XIX : Mean and SD of different age estimation methods of different age groups

Age groups Age in years


Mean SD Mean SD Mean SD I

24


27-32 years 28.26 1.33 15.9 0.12 18.88 0.80 II

22-26 years 21.0 1.13 15.49 5.95 19.78 3.36 III

17-21 years 19.00 1.60 13.75 1.31 19.90 3.09 IV 12-16 years 14.86 1.45 11.85 1.65 17.69

4.17 V

7-11 years 9.26 0.96 7.55 1.28 17.09 3.24 Total 7-27 years 18.48 6.50 12.91 4.15 18.67 3.26

This shows the mean and standard deviation of chronological age and dental age by Willems method and Kvaal’s method for age groups.

Table XX : Descriptive statistics of two age estimation methods

Age groups Age in years


Minimum Maximum Minimum Maximum Minimum Maximum I

27-32 years 26 31 15.79 16 16.60 20.22 II

22-26 years 19 23 10.37 35.74 11.08 22.90 III

17-21 years 16 21 11.27 16.03 14.47 26.15 IV 12-16 years

13 18 9.41 14.55 9.76 22.48 V

7-11 years 8 11 5.34 10.08 5.97 19.78

Table XXI : Confidence Interval for different age estimation methods

Group

Age in years

CA (95% CI) Willem’s method (95% CI) Kvaal’s method (95% CI)

Upper bound Lower bound Upper bound Lower bound Upper bound Lower bound I

27-32 27.52 29.00 15.83 15.83 18.43 19.33 II

22-26 20.37 21.19 12.19 12.19 17.91 21.64 III

17-21 18.11 19.88 13.02 13.02 18.18 21.61 IV 12-16

14.05 15.67 10.94 10.94 15.37 20 V

7-11 8.73 9.79 6.84 6.84 15.29 18.88

25


Table XXII : Mean age of different age estimation methods by gender

Gender N Mean Std. Deviation Std. Error Mean CA Male 24 20.8750 6.37463 1.30122

Female 51 17.3529 6.30816 .88332 Willem Male 24 15.1017 5.11721 1.04455

Female 51 11.8829 3.17280 .44428 Kvaal Male 24 19.8875 2.14479 .43780

Female 51 18.0972 3.54679 .49665

Table XXI : Levene’s Test and t-test for Equality of Variances

Levene’s Test for Equality of Variances t-test for Equality of Variances

F Sig. t df CA Willem Kvaal .141 .000 1.685 .708 .992 .198 2.248 3.341 2.280 73 73 73

Table XXII : Mean differences and Standard error differences of different age estimation methods

t-test for Equality of Means

Sig. (2-tailed) Mean Difference Std. Error Difference 95% Confidence Interval of the Difference

Lower CA Equal variances assumed .028 3.52206 1.56671 .39962

Equal variances not assumed .030 3.52206 1.57271 .35390 Willem Equal variances assumed.001 3.21873 .96334 1.29879

Equal variances not assumed .008 3.21873 1.13510 .90544 Kvaal Equal variances assumed .026 1.79028 .78534 .22510

Equal variances not assumed .009 1.79028 .66207 .46925

Chart 1 : Distribution of the subjects by their age and gender

Male Group I Group II Group III Group IV Group V 0.47000000000000008 0.47000000000000008 0.33000000000000163 0.13 0.2 Female Group I Group II Group III Group IV Group V 0.53 0.53 0.67000000000000326 0.86000000000000065 0.8

Chart 2 : Mean chronological age of different age groups

CA 27-32 yrs 22-26yrs 17-21yrs 12-16yrs 7-11yrs 28.259999999999987 21 19 14.860000000000024 7.55

Chart 3 : Mean estimated dental age of different age groups by Willem’s method

Willem's method 27-32 yrs 22-26yrs 17-21yrs 12-16yrs 7-11yrs 15.9 15.49 13.75 11.850000000000026 7.55

Chart 4 : Mean estimated dental age of different age groups by Kvaal’s method

26


Kvaal's method 27-32 yrs 22-26yrs 17-21yrs 12-16yrs 7-11yrs 18.88 19.779999999999987 19.899999999999999 17.690000000000001 17.09

Chart 5 : Mean estimated dental age of different age groups by different age estimation methods

CA 27-32

0: http://www.aapd.org/assets/1/7/Periodicity-RhodeIsland.pdf 68%

1: https://www.uhccommunityplan.com/content/dam/communityplan/healthcareprofessionals/providerinformation/RI-Provider-Information/RI_Early_Periodic_Screening_Diagnosis_Treatment.pdf 68%

2: http://mb.cision.com/Main/14691/2328151/710950.pdf 62%

yrs 22-26yrs 17-21yrs 12-16yrs 7-11yrs 28.259999999999987 21 19 14.860000000000024 9.26 WILLEM'S 27-32yrs 22-26yrs 17-21yrs 12-16yrs 7-11yrs 15.9 15.49 13.75 11.850000000000026 7.55 Kvaal's 27-32yrs 22-26yrs 17-21

yrs 12-16yrs 7-11yrs 18.88 19.779999999999987 19.899999999999999 17.690000000000001 17.09


Male CA Willem's Kvaal's 20.87 15.1 19.88


Female CA Willem's Kvaal's 17.350000000000001 11.88 18.09

DISCUSSION

Forensic odontology or forensic dentistry is the application of dental knowledge to those criminal and civil laws that are enforced by police agencies in the criminal justice system. It is the most unfamiliar and conspiring branch of forensic sciences.72 There are three important areas of activity embracing the modern forensic odontology.73 First, comes the evaluation and examination of injuries to the jaws, oral tissues and to teeth resulting from various causes. Secondly, with a view of the examination of marks to possible identification or subsequent elimination of a suspect as the predator. Thirdly, examination of fragments or complete dental remains (including all types of dental restoration) to a possible identification of the latter. Several methods have been developed to estimate the age of individuals such as morphological, biochemical and radiological methods. Most morphological methods require extractions, and microscopic preparations of at least one tooth from the individual.74 These methods cannot be used in living individuals and in cases where it is not acceptable to extract teeth for ethical, religious, cultural, or scientific reasons. Radiographic assessment of age is a

27


simple, non-invasive and reproducible method that can be employed both on living and unknown dead, either in identification cases or archaeological investigations.75 Edwin Saunders 76 showed that teeth were more accurate assessment of age than height. Gustafson 77 made the earliest systematic attempt to estimate age from radiographs, using macro structural change and is the most popular age estimation test employed by forensic odontologists and pathologists. Since then age estimation using dental parameters has been used in forensic science.76 In 1995,Kvaal et al presented a method to estimate the age on periapical radiographs, 78 whereas Paewinsky et al verified the applicability of this method on orthopantomographs.40 In the present study, orthopantomographs were used for age prediction. Most of the previous studies on panoramic radiographs methods of age prediction using pulp tooth ratio were carried out on single rooted teeth using regression model. (74,36,40) The problems associated with orthopantomographs are the superimposition of anatomical structures especially in the anterior region. Also the assessment of pulp cavity of maxillary teeth was found to be difficult because the maxillary posterior teeth are often overlapped by bony structures.71 So, the right mandibular first molar was chosen for the measurement on intra oral periapical radiograph. Johanson (1971) found that correlation between the age and height of pulp chamber was somewhat stronger than that reported for all teeth in methods for age calculation.79

In 1973, Demirjian introduced a method (DemI973) which estimated chronological age based on developments of seven teeth from the left side of the mandible. This method has been tested in various populations and has been mostly reported to overestimate the age of an individual.80 In 2001, Willems et al., evaluated the accuracy of Demirjian method in Belgian Caucasian population and modified the scoring system when a significant overestimation was reported.81This modification has been evaluated among various communities and has been reported to be more accurate compared with the original method.

In this present study, the sample was divided into 5 groups, group I was of ages >32, shows that the mean age and standard deviation were found to be 15.9 in Willem’s method and 18.88 in Kvaal’s method. group II was of ages >26, shows that the mean age and standard deviation were found to be 15.49 in Willem’s method and 17.78 in Kvaal’s method. group III was of ages >21, shows that the mean age and standard deviation were found to be 13.75 in Willem’s method and 19.90 in Kvaal’s method. group IV was of ages >16, shows that the mean age and standard deviation were found to be 11.85 in Willem’s method and 17.69 in Kvaal’s method. group V was of ages >11, shows that the mean age and standard deviation were found to be 7.55 in Willem’s method and 17.09 in Kvaal’s method. In the present study, the overall mean difference between the estimated DA and CA for males was 15.10 years while for females was 11.88 years. These gender differences in the entire sample were not statistically significant. When comparison among gender is done, females mature earlier than males, but the mean difference between DA and CA was not statistically significant. Estimated dental age assessment by Willem’s method appeared to underestimate chronological age both in males and females. However, the difference was greater in females when compared to males. The estimated by Willem’s method was compared with the “gold standard” chronological age. The difference was reported as the mean age difference. Mean difference is considered to be more appropriate measure of accuracy than other measure accuracy including correlation

28


coefficient because it allows understanding the difference between the chronological age and estimated dental age in units, i.e., in decimal years.39

A recent study by RB Mohammed et al., conducted among South Indian children who concluded that mean dental age showed significant underestimation of 0.7 ± 1.69 years and 0.11 ± 1.3 years in boys and girls respectively [58]. However a study conducted among North Indian population by Grover et al. reported that the method overestimated age of girls and boys by 0.24 and 0.36 years respectively.82

Jyotsna et al reported that Willems method underestimated the mean age of males by 0.69 years and females by 0.08 years and showed that females mature earlier than males in selected population. The mean difference between DA and CA according to Willems method was 0.39 years and is statistically significant (P > 0.05).83 In Kvaal’s method, the mean value of pulp chamber height and crown root trunk height, pulpal width at CEJ and width of crown at CEJ was assessed respectively. It was observed that as the age increases the height of pulp chamber decreases, there was no significant difference between male and female subjects. The width of the pulp at the level of cementoenamel junction was also found to decrease with age. The age of the subjects had no influence on the crown root height and the width of crown at the level of cementoenamel junction. In 2000, Schulze et al.,84 investigated the accuracy of the measurements of the morphological parameters of teeth in orthopantomograms. He opined that vertical measurements were less reproducible and accurate than horizontal. In the present study, high reproducibility was found in both vertical and horizontal measurements. However, maximum standard deviation was seen in pulp length measurement (vertical parameter). Hence, it could be suggested that horizontal measurements are more reproducible than vertical measurements. Similar age estimation studies were done on OPG by Cameriere et al.,85 and Bosmans et al.,74 and P value < 0.05, indicated no significant difference between the estimated and chronological age. In present study, the P value was <0.05, indicating significantly positive result. Hence,

no statistically significant difference was found between the estimated age and the actual chronological age.

A study based on the concept




that with advancing age the size of pulp cavity is reduced because of secondary

dentin deposit had been carried out in 1995 as an indicator of age

29


by Kvaal et al. 78 A study published by Sharma and Srivastava 86 in 2010 mentions the use of digital intraoral periapical radiographs for estimation of age of individuals, wherein the authors have obtained population specific regression formulae to estimate age based on the Kvaal’s technique. Although the results obtained were slightly different from the original Kvaal’s study (1995) used on conventional radiographs, the authors have suggested the possibility of use of this method for age estimation. Recently, a study has been published by Kanchan-Talreja et al. 87 in which, the original Kvaal’s formulae have been tested on digital intraoral periapical radiographs and have led to large errors in age estimation. The authors in the same study have also developed population specific formulae which again led to errors in age calculation but to a smaller extent than applying the original formulae. It is to be noted that the conventional method and prescribed instrumentation (such as stereomicroscope) used in the original study were not used in the above mentioned studies which could have been a possible reason for the variation in the achieved results. Moreover, it is equally important to realize that no age estimation will accurately determine the exact age for every individual since development naturally varies between individuals. Moreover, DA is not same for all children of a specific known age. Most important aspect of DA estimation is to remember that one should not restrict to only one age estimation technique, but to apply different techniques available and perform repetitive measurements and calculations.


We started our study with an aim to evaluate the accuracy of two methods in determining the relation between dental age and chronological age We selected seventy five patients who were referred from the Department of Orthodontics for taking Radiographs for treatment purpose. The patients were grouped into five :7 males and 8 females of age ranging from 27-32 years were in group I; 7 males and 8 females of age ranging from 22-26 years were in group II; 5 males and 10 females of age ranging from 17-21 years were in group III; 2 males and 13 females of age ranging from 12-16 years were in group IV; 3 males and 12 females of age ranging from 7-11 years were in group V.

Chronological age of a subject was calculated from the date on which the radiographs were exposed

by subtracting the birth date for that particular individual. The dental age was determined using orthopantamographs by Willem’s method and using Intra oral periapical radiograph by Kvaal’s method. The results were analysed. In this study, significant relation was found between estimated DA and CA in Willem method (p-0.00) and Kvaal’s method (p-0.05). Both the methods seems to be applicable in estimating age of both genders.

LIMITATIONS OF THE STUDY

• The difference between the Chronological age and Calculated age is due to tooth formation stages are not equally spaced during growth and are not of equal duration. • When a three-dimensional image is projected on a two-dimensional film receptor, a discrepancy may occur in the morphologic measurements of the tooth. • A proper visual discrimination between

30


formation stages is necessary, because it remains subjective and even a one stage difference may have an impact on DA.

[Type the document title]

Page 14

Female CA Willem's Kvaal's 17.350000000000001 11.88 18.09

CA 27-32 yrs 22-26yrs 17-21yrs 12-16yrs 7-11yrs 28.259999999999987 21 19 14.860000000000024 7.55

Male CA Willem's Kvaal's 20.87 15.1 19.88

Male Group I Group II Group III Group IV Group V 0.47000000000000008 0.47000000000000008 0.33000000000000163 0.13 0.2 Female Group I Group II Group III Group IV Group V 0.53 0.53 0.67000000000000326 0.86000000000000065 0.8

CA 27-32





yrs 12-16yrs 7-11yrs 18.88 19.779999999999987 19.899999999999999 17.690000000000001 17.09

Kvaal's method 27-32 yrs 22-26yrs 17-21yrs 12-16

yrs 7-11yrs 18.88 19.779999999999987 19.899999999999999 17.690000000000001 17.09

Willem's method 27-32 yrs 22-26yrs 17-21yrs 12-16yrs 7-11yrs 15.9 15.49 13.75 11.850000000000026 7.55

[Metadata removed]

31


Hit and source - focused comparison, Side by Side:

Left side: As student entered the text in the submitted document. Right side: As the text appears in the source.

Instances from: SAAR och NIBE.pdf


A begining of calcification is seen at the superior level of crypt in the form of cones. There is no fusion of these calcified points. B Fusion of the calcified points forms one or more cusps, giving a regularly outlined occlusal surface C Enamel


a beginning of calcification is seen at the superior level of the crypt in the form of an inverted cone or cones. There is no fusion of these calcified points. B Fusion of the calcified points forms one or several cusps which unite to give a regularly outlined occlusal surface. C a) Enamel


formation is complete at the occlusal surface and converge at cervical region. Dentin deposition is seen. The outline of the pulp chamber has a curved shaped at the occlusal border. D Crown formation is completed down to the cementoenamel junction. Superior border of pulp chamber in uniradicular teeth has a definite curved form; projection of pulp horns gives an umbrella top. In molars, pulp chamber has a trapezoidal form. Begining of root formation is seen in the form of a spicule E Uniradicular


formation is complete at the occlusal surface. Its extension and convergence towards the cervical region is seen. b) The beginning of a dentinal deposit is seen c) The outline of the pulp chamber has a curved shape at the occlusal border. D a) The crown formation is completed down to the cementoenamel junction. b) The superior border of the pulp chamber in the uniradicular teeth has a definite curved form, being concave towards the cervical region. The projection of the pulp horns if

32


teeth The walls of pulp chamber form straight lines, whose continuity is broken by the pulp horn. The root length is less than the crown height. In Molars Initiation of radicular bifurcation is seen as a calcified point or a semi-lunar shape. Root length is less than crown height. F Uniradicular teeth The walls of pulp chamber form isosceles triangle. Apex ends in a funnel shaped. The root length is equal

present, gives an outline shaped like an umbrella top. In molars the pulp chamber has a trapezoidal form. c) Beginning of root formation is seen in the form of a spicule. E Uniradicular teeth: a) The walls of the pulp chamber now form straight lines, whose continuity is broken by the presence of the pulp horn, which is larger than in the previous stage. b) The root length is less than the crown height. Molars: a) Initial formation of the radicular bifurcation is seen in the form of either a calcified point or a semi-lunar shape. b) The root length is still less than the crown height. F Uniradicular teeth : a) The walls of the pulp chamber now form a more or less isosceles triangle. The apex ends in a funnel shape. b) The root length is equal


or greater than the crown height. In molars The bifurcation has developed down to give the roots a distant outline with funnel shaped endings. Root length is equal to or greater than crown height. G The walls of root canal are now parallel and its apical end is partially open(distal root in molars) H The apical end of the root canal is


and apex.


or greater than the crown height. Molars: a) The calcified region of the bifurcation has developed further down from its semi-lunar stage to give the roots a more definite and distinct outline with funnel shaped endings. b) The root length is equal to or greater than the crown height 7. The walls of the root canal are now parallel and its apical end is still partially open (distal root in molars). 8. a) The apical end of the root canal is completely closed. (Distal root in molars). b) The periodontal membrane has a uniform width around the root and the apex.

33

33


Instances from: Liljana Simonsson Mastersarbete 2013.docx




completely closed, and the periodontal membrane has a uniform width around the root.

34


Instances from: Liljana Simonsson Mastersarbete 2013.docx




completely closed, and the periodontal membrane has a uniform width around the root.

35


Instances from: http://mb.cision.com/Main/14691/2328151/710950.pdf




yrs < 2.5 yrs < 3.0 yrs < 3.5 yrs < 4.0 yrs 4 10 15 24 47 76 212 109 171 0 50 100 150 200 250 Completed < 0.5 yrs < 1.0 yrs < 1.5 yrs < 2.0 yrs < 2.5 yrs < 3.0 yrs < 3.5 yrs < 4.0 yrs




yrs < 2.5 yrs < 3.0 yrs < 3.5 yrs < 4.0 yrs 4 10 15 24 47 76 212 109 171 0 50 100 150 200 250 Completed < 0.5 yrs < 1.0 yrs < 1.5 yrs < 2.0 yrs < 2.5 yrs < 3.0 yrs < 3.5 yrs < 4.0 yrs

36


Instances from: http://www.aapd.org/assets/1/7/Periodicity-RhodeIsland.pdf



yrs 12-16yrs 7-11yrs 18.88 19.779999999999987 19.899999999999999 17.690000000000001 17.09


Yrs Yrs Yrs Yrs Yrs Yrs Yrs Yrs Yrs Yrs Yrs Yrs Yrs Yrs Yrs



yrs 12-16yrs 7-11yrs 18.88 19.779999999999987 19.899999999999999 17.690000000000001 17.09



Yrs Yrs Yrs Yrs Yrs Yrs Yrs Yrs Yrs Yrs Yrs Yrs Yrs Yrs Yrs

Yrs Yrs Yrs

37


Instances from: https://link.springer.com/article/10.1007/s00414-004-0492-x



varying root levels


pulp/root length, pulp/tooth length and pulp/root width at three

different root levels.


the



The width ratios of the pulp cavity showed significant correlation to the chronological age and the coefficient of determination (r2) was highest in the upper lateral incisors (


Ratios of



ratios of distances were calculated:


38


Instances from: http://www.rguhs.ac.in/cdc/onlinecdc/uploads/02_D032_18607.doc




pulp/tooth length, tooth/root length and pulp/root width at three




width ratios of the pulp cavity to the chronological age and concluded that the coefficient of determination was highest in the upper lateral incisors



levels


pulp/root length,


different levels.

39


Instances from: https://www.researchgate.net/publication/51369645_Quantification_of_secondary_dentine_formation_from_orthopantomograms_-_A_contribution_to_forensic_age_estimation_methods_in_adults



varying root levels



different root levels.


the



The width ratios of the pulp cavity showed significant correlation to the chronological age and the coefficient of determination (r 2) was highest in the upper lateral incisors (

16: https://www.researchgate.net/publication/51369645_Quantification_of_secondary_dentine_formation_from_orthopantomograms_-

16: https://www.researchgate.net/publication/51369645_Quantification_of_secondary_dentine_formation_from_orthopantomograms_-

40


_A_contribution_to_forensic_age_estimation_methods_in_adults 80%

Ratios of


_A_contribution_to_forensic_age_estimation_methods_in_adults 80%

ratios of distances were calculated:


41


Instances from: https://www.researchgate.net/publication/15640872_Age_estimation_of_adult_from_radiographs









maxillary central and lateral incisors and second premolars, and mandibular lateral incisors, canines and first premolars.



levels


pulp/root length,


different levels.

42






that with advancing age the size of the dental pulp cavity is reduced as a result of secondary dentine deposit, so that measurements of this reduction can be used as an indicator of age.

43


Instances from: https://www.sciencedirect.com/science/article/pii/037907389501760G









maxillary central and lateral incisors and second premolars, and mandibular lateral incisors, canines and first premolars.



levels


pulp/root length,


different levels.

44







45


Instances from: https://www.readbyqxmd.com/read/7557754/age-estimation-of-adults-from-dental-radiographs







levels


pulp/root length,


different levels.






46


Instances from: https://www.uhccommunityplan.com/content/dam/communityplan/healthcareprofessionals/providerinformation/RI-Provider-Information/RI_Early_Periodic_Screening_Diagnosis_Treatment.pdf



yrs 12-16yrs 7-11yrs 18.88 19.779999999999987 19.899999999999999 17.690000000000001 17.09


YRS YRS YRS YRS YRS YRS YRS YRS YRS YRS YRS YRS YRS YRS YRS



yrs 12-16yrs 7-11yrs 18.88 19.779999999999987 19.899999999999999 17.690000000000001 17.09


YRS YRS YRS YRS YRS YRS YRS YRS YRS YRS YRS YRS YRS YRS YRS

YRS YRS YRS

47



48


Instances from: https://www.bafo.org.uk/wp-content/uploads/2011-11-26-recent-publications.pdf




pulp/root length ratio, pulp/tooth length ratio, pulp/root width ratio at




radiographic images of the right maxillary canine in each case were processed using a computer aided drafting program. Pulp/tooth area ratio,


the cemento-enamel junction level, pulp/root width ratio at midroot level, and pulp/root width ratio at

49


Instances from: http://www.pubpdf.com/pub/25177137/Age-estimation-using-pulptooth-area-ratio-in-maxillary-canines-A-digital-image-analysis

13: http://www.pubpdf.com/pub/25177137/Age-estimation-using-pulptooth-area-ratio-in-maxillary-canines-A-digital-image-analysis

84%



84%



52%



52%

radiographic images of the right maxillary canine in each case were processed using a computer aided drafting program. Pulp/tooth area ratio,



50


Instances from: https://pdfs.semanticscholar.org/cdeb/e67c3a1d85b7fb4807a2561e7231961af6e8.pdf


ranged from 19 to 75 years. There was no significant difference between


ranged from -2.2 to +1.5 years. There was no significant difference between








radiographic images of the right maxillary canine in each case were processed using a computer aided drafting program. Pulp/ tooth area ratio,



51


CERTIFICATE - II

This is to certify that this dissertation work titled COMPARISON OF

TWO METHODS IN ESTIMATING THE RELATION BETWEEN

DENTAL AGE AND CHRONOLOGICAL AGE of the candidate

Dr.G.SURYA with registration Number 241527403 for the award of MASTER

OF DENTAL SURGERY in the branch of ORAL MEDICINE AND

RADIOLOGY. I personally verified the urkund.com website for the purpose of

plagiarism Check. I found that the uploaded thesis file contains from introduction

to conclusion pages and result shows 5 percentage of plagiarism in the dissertation.

Guide & Supervisor sign with Seal.

comparison of two methods in estimating the …repository-tnmgrmu.ac.in › 9810 › 1 ›...

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