The reliability of Cameriere's method in Turkish children: A preliminary report

Highlights

• A sample of 573 digital panoramic radiographs of healthy Turkish children, aged between 8 and 15 years, was studied.

• Radiographs of the left permanent developing mandibular teeth, were evaluated.

• Cameriere's method is more accurate for girls than for boys in the tested population.

Abstract

Dental age estimation in children is an important issue both legally and medically. Currently, however, there is a lack of contemporary dental age estimation standards for a Turkish population. This study assessed the accuracy of Cameriere's method by examining the panoramic radiographs of 573 healthy Turkish children between the ages of 8 and 15 years. Radiographs of the left permanent developing mandibular teeth, except wisdom teeth, were evaluated. All subjects were divided into 7 groups according to their chronological age. The Intra-class Correlation Coefficient was used to determine the intra- and inter-observer agreement error. A comparison of the distributions of estimation errors among age groups was performed using the Nemenyi test. There were no significant differences between inter-observer (p = 0.352), and intra-observer readings after 2 weeks (p = 0.275 and p = 0.273, respectively). The dental age was underestimated when using Cameriere's method with a mean difference of −0.35 years (−0.24 years for girls and −0.47 years for boys). The median values of the differences between dental and chronological age were −0.44 years in boys (range: −3.70, 4.06) and −0.21 years in girls (range: −2.74, 3.29). In addition, the differences between dental and chronological ages in the different age groups decreased with increasing chronological age. Results from the Nemenyi test implied that Cameriere's method is more accurate for girls than for boys in this cohort of a Turkish population.

Introduction

Age estimation in children is a fundamental challenge in pediatric endocrinology and in orthodontic treatment [1]. Orthodontists use such knowledge to predict the timing of particular treatments and pediatricians may be interested in knowing whether the dental maturity of a child with a certain disease has been delayed or advanced [2], [3]. Age estimation is also an important requisite in some judicial proceedings: asylum seekers of unknown age, young people accused of criminal activities, and convicted criminals whose age is claimed to be less than 18 years prior to sentencing [4], [5].

It is generally accepted that several indicators of somatic development such as skeletal, dental and menarche ages, somatic maturity, sexual maturation and body size, can be used to assess the growth and development of children [6], [7].

Today, according to the recommendations of the Study Group on Forensic Age Diagnostics (AGFAD) [4], the examination of three independent development systems are combined in criminal proceedings, to increase diagnostic accuracy and to improve the identification of age-relevant development disorders [1], [2], [3]. The latest version of these recommendations can be found on the AGFAD website at http://agfad.uni-muenster.de/german/start.htm.

Dental maturity indicators are thought to be more useful indices of maturation since they is less likely to vary in response to nutritional and environmental insults, especially compared to other commonly studied age markers, such as tooth emergence and skeletal growth [8], [9], [10], [11].

Dental age is in most practical cases estimated from the development of the teeth either by eruption of teeth or by grading the development of tooth crown and roots on radiographs. The developmental stages of the selected teeth are described from initiation (crypt stage) to completion (closure of the dental root apex) [12], [13].

Various methods employed for assessing dental age are based on the degree of the calcification observed in radiographic examinations of permanent teeth [14]. Among these proposed methods, one of the most widely applied methods is the eight stage system introduced by Demirjian and Goldstein (subsequently referred as Demirjian's method) [15]. However, its test in many populations has resulted in relatively wide variations between predicted and actual age, allowing several authors to suggest the use of population-based standards [16], [17], [18], [19]. Kirzioğlu and Ceyhan showed that Demirjian's method is not suitable for Turkish children and establishment of the population-specific standards is essential and crucial [20]. According to the results of Tunc and Koyuturk [17], the standards of dental age described by Demirjian et al. in 1973 and 1976 may not be suitable for northern Turkish children.

The score system of Willems et al. [21] is the best adaptation of Demirjian's method and is the recommended method of choice to assess maturity or estimate age if all seven teeth are available.

Recently, a novel method was developed by Cameriere et al. [1] for assessing dental age in children. The technique is based on the relationship between age and measurement of open apices. The method has been tested on samples from Kosovo and Slovenia [22] as well as various European countries, in search of a common formula useful for estimating dental age in all countries [23], [24], [25]. Several studies have reported that Cameriere's method is more accurate than other methods for estimating the age of children in the age group of 6–13 years [26], [27], [28], [29], [30], [31]. Recently, Marques Fernandes et al. [31] proved the accuracy of this method in a Brazilian sample of 160 children aged between 5 and 15 years. De Luca et al. [32] showed that this technique is very useful and may be recommended for practical application both in clinical dentistry and forensic procedures on the Mexican population.

In the light of previous reports, the aim of the present study is to determine the reliability of the Cameriere's method in a sample of Turkish children.