Abstract
Evaluation of the radiographic visibility of root pulp in mandibular third molars has been suggested as an alternative method for estimation of legal age threshold in living individuals when the root apices are mature. Here, we assessed the accuracy of this method for age thresholds of 18 and 21 years. A sample of 463 panoramic radiographs of individuals aged between 16 and 34 years was examined. The root pulp visibility of the mandibular third molars was scored; the stages ranged from 0 to 3. A receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC) were used to select optimal cut-offs for 18- and 21-year-old thresholds. As prognostic predictors, the selected cut-offs were stages 1 and 2 for the 18- and 21-year-old thresholds of both sexes, respectively. For the 18-year-old threshold, the AUC, sensitivity and specificity were 0.829, 83.1% and 66.7% in females; and 0.930, 89.4% and 90.9% in males, respectively. For the 21-year-old threshold, the AUC, sensitivity and specificity were 0.874, 72.8% and 92.0% in females; and 0.906, 85.5% and 88.2% in males, respectively. The accuracy of the method for estimating the 18- and 21-year-old thresholds ranged from moderate to high. Therefore, the method must be used in conjunction with other age estimation methods, especially to predict whether a female has reached 18 years of age.
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References
Lewis JM, Senn DR (2013) Dental age estimation. In: Senn DR, Weems RA (eds) Manual of forensic odontology, 5th edn. CRC Press Taylor & Francis Group, Boca Raton, pp 211–255
Büken B, Demir F, Büken E (2003) Evaluation of cases sent for age estimation to forensic medicine department between 2001 and 2003 years and difficulties in forensic practice. Düzce Med J 5:18–23
Harunoğulları M (2016) Suriyeli sığınmacı çocuk işçiler ve sorunları: Kilis örneği. Göç Derg 3:29–63 (in Turkish)
Thevissen PW, Kvaal SI, Dierickx K, Willems G (2012) Ethics in age estimation of unaccompanied minors. J Forensic Odontostomatol 30(sup. 1):85–102
Jayaraman J, Roberts GJ, Wong HM, McDonald F, King NM (2016) Ages of legal importance: implications in relation to birth registration and age assessment practices. Med Sci Law 56:77–82. https://doi.org/10.1177/0025802415590172
Turkish Penal Code. Law no.: 5237 (2004) Official Gazette 2004; (25611) (in Turkish)
Schmeling A, Grundmann C, Fuhrmann A, Kaatsch H-J, Knell B, Ramsthaler F, Reisinger W, Riepert T, Ritz-Timme S, Rösing FW, Rötzscher K, Geserick G (2008) Criteria for age estimation in living individuals. Int J Legal Med 122:457–460. https://doi.org/10.1007/s00414-008-0254-2
Cunha E, Baccino E, Martrille L, Ramsthaler F, Prieto J, Schuliar Y, Lynnerup N, Cattaneo C (2009) The problem of aging human remains and living individuals: a review. Forensic Sci Int 193:1–13. https://doi.org/10.1016/j.forsciint.2009.09.008
Streckbein P, Reichert I, Verhoff MA, Bödeker RH, Kähling C, Willbrand JF, Schaaf H, Howaldt HP, May A (2014) Estimation of legal age using calcification stages of third molars in living individuals. Sci Justice 54:447–450. https://doi.org/10.1016/j.scijus.2014.08.005
Olze A, Solheim T, Schulz R, Kupfer M, Schmeling A (2010) Evaluation of the radiographic visibility of the root pulp in the lower third molars for the purpose of forensic age estimation in living individuals. Int J Legal Med 124:183–186. https://doi.org/10.1007/s00414-009-0415-y
Olze A, Solheim T, Schulz R, Kupfer M, Pfeiffer H, Schmeling A (2010) Assessment of the radiographic visibility of the periodontal ligament in the lower third molars for the purpose of forensic age estimation in living individuals. Int J Legal Med 124:445–448. https://doi.org/10.1007/s00414-010-0488-7
Perez-Mongiovi D, Teixeira A, Caldas IM (2015) The radiographic visibility of the root pulp of the third lower molar as an age marker. Forensic Sci Med Pathol 11:339–344. https://doi.org/10.1007/s12024-015-9688-2
Lucas VS, McDonald F, Andiappan M, Roberts G (2017) Dental age estimation-root pulp visibility (RPV) patterns: a reliable mandibular maturity marker at the 18 year threshold. Forensic Sci Int 270:98–102. https://doi.org/10.1016/j.forsciint.2016.11.004
Timme M, Timme WH, Olze A, Ottow C, Ribbecke S, Pfeiffer H, Dettmeyer R, Schmeling A (2017) The chronology of the radiographic visibility of the periodontal ligament and the root pulp in the lower third molars. Sci Justice 57:257–261. https://doi.org/10.1016/j.scijus.2017.03.004
Guo YC, Chu G, Olze A, Schmidt S, Schulz R, Ottow C, Pfeiffer H, Chen T, Schmeling A (2018) Application of age assessment based on the radiographic visibility of the root pulp of lower third molars in a northern Chinese population. Int J Legal Med 132:825–829. https://doi.org/10.1007/s00414-017-1731-2
Sequeira CD, Teixeira A, Caldas IM, Afonso A, Pérez-Mongiovi D (2014) Age estimation using the radiographic visibility of the periodontal ligament in lower third molars in a Portuguese population. J Clin Exp Dent 6:e546–e550. https://doi.org/10.4317/jced.51813
Chaudhary MA, Liversidge HM (2017) A radiographic study estimating age of mandibular third molars by periodontal ligament visibility. J Forensic Odontostomatol 2:79–89
Goksuluk D, Korkmaz S, Zararsiz G, Karaagaoglu AE (2016) easyROC: an interactive web-tool for ROC curve analysis using R language environment. The R Journal 8(2):213–230
R Core Team (2018) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna https://www.R-project.org/
Youden WJ (1950) Index for rating diagnostic tests. Cancer 3(1):32–35
Akobeng AK (2007) Understanding diagnostic tests 2: likelihood ratios, pre- and post-test probabilities and their use in clinical practice. Acta Pediatr 96:487–491. https://doi.org/10.1111/j.1651-2227.2006.00179.x
Landis J, Koch G (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174. https://doi.org/10.2307/2529310
Brown LD, Cai TT, DasGupta A (2001) Interval estimation for a binomial proportion. Stat Sci 16:101–117
Kvaal SI, Kolltveit KM, Thomsen IO, Solheim T (1995) Age estimation of adults from dental radiographs. Forensic Sci Int 74:175–185. https://doi.org/10.1016/0379-0738(95)01760-G
Solari AC, Abramovitch K (2002) The accuracy and precision of third molar development as an indicator of chronological age in Hispanics. J Forensic Sci 47(3):531–535
Schmeling A, Olze A, Reisinger W, Geserick G (2004) Forensic age diagnostics of living people undergoing criminal proceedings. Forensic Sci Int 144:243–245. https://doi.org/10.1016/j.forsciint.2004.04.059
Thevissen PW, Kaur J, Willems G (2012) Human age estimation combining third molar and skeletal development. Int J Legal Med 126(2):285–292. https://doi.org/10.1007/s00414-011-0639-5
Garamendia PM, Landaa MI, Ballesterosb J, Solano MA (2005) Reliability of the methods applied to assess age minority in living subjects around 18 years old a survey on a Moroccan origin population. Forensic Sci Int 154:3–12. https://doi.org/10.1016/j.forsciint.2004.08.018
Pinchi V, De Luca F, Focardi M, Pradella F, Vitale G, Ricciardi F, Norelli G-A (2016) Combining dental and skeletal evidence in age classification: pilot study in a sample of Italian sub-adults. Legal Med 20:75–79. https://doi.org/10.1016/j.legalmed.2016.04.009
Cameriere R, Ferrante L, Cingolani M (2004) Variations in pulp/tooth area ratio as an indicator of age: a preliminary study. J Forensic Sci 49:317–319. https://doi.org/10.1520/JFS2003259
Orhan K, Ozer L, Orhan AI, Dogan S, Paksoy CS (2007) Radiographic evaluation of third molar development in relation to chronological age among Turkish children and youth. Forensic Sci Int 165:46–51. https://doi.org/10.1016/j.forsciint.2006.02.046
Mincer H, Harris E, Berryman H (1993) The A.B.F.O. study of third molar development and its use as an estimator of chronological age. J Forensic Sci 38(2):379–390. https://doi.org/10.1520/JFS13418J ISSN 0022-1198
Knell B, Ruhstaller P, Prieels F, Schmeling A (2009) Dental age diagnostics by means of radiographical evaluation of the growth stages of lower wisdom teeth. Int J Legal Med 123:465–469. https://doi.org/10.1007/s00414-009-0330-2
Olze A, Schmeling A, Taniguchi M, Maeda H, van Niekerk P, Wernecke KD, Geserick G (2004) Forensic age estimation in living subjects: the ethnic factor in wisdom tooth mineralization. Int J Legal Med 118:170–173. https://doi.org/10.1007/s00414-004-0434-7
Levesque GY, Demirjian A, Tanguay R (1981) Sexual dimorphism in the development, emergence, and agenesis of the mandibular third molar. J Dent Res 60(10):1735–1741. https://doi.org/10.1177/00220345810600100201
Swets JA (1988) Measuring the accuracy of diagnostic systems. Science 240:1285–1293. https://doi.org/10.1126/science.3287615
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Akkaya, N., Yılancı, H.Ö., Boyacıoğlu, H. et al. Accuracy of the use of radiographic visibility of root pulp in the mandibular third molar as a maturity marker at age thresholds of 18 and 21. Int J Legal Med 133, 1507–1515 (2019). https://doi.org/10.1007/s00414-019-02036-x
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DOI: https://doi.org/10.1007/s00414-019-02036-x