Age assessment by Demirjian’s development stages of the third molar: a systematic review
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Radiographic evaluation of the wisdom teeth (third molar) formation is a widely used age assessment method for adolescents and young adults. This systematic review examines evidence on the agreement between Demirjian’s development stages of the third molar and chronological age.
We searched four databases up until May 2016 for studies reporting Demirjian’s stages of third molar and confirmed chronological age of healthy individuals aged 10–25 years. Heterogeneity test of the included studies was performed.
We included 21 studies from all continents except Australia, all published after 2005. The mean chronological age for Demirjian’s stages varied considerably between studies. The results from most studies were affected by age mimicry bias. Only a few of the studies based their results on an unbiased age structure, which we argue as important to provide an adequate description of the method’s ability to estimate age.
Observed study variation in the timing of Demirjian’s development stages for third molars has often been interpreted as differences between populations and ethnicities. However, we consider age mimicry to be a dominant bias in these studies. Hence, the scientific evidence is insufficient to conclude whether such differences exist.
• There is significant heterogeneity between studies evaluating age assessment by Demirjian’s third molar development.
• Most of the studies were subject to the selection bias age mimicry which can be a source of heterogeneity.
• Presence of age mimicry bias makes it impossible to compare and combine results. These biased studies should not be applied as reference studies for age assessment.
KeywordsAge determination by teeth Molar, third Odontogenesis Adolescent Young adult
The authors thank Marit Johansen for peer review of the literature search strategy.
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is the last author, Gunn Elisabeth Vist, Division for Health Services, Norwegian Institute of Public Health, Norway.
Conflict of interest
The authors declare that they have no conflict of interest.
Statistics and biometry
Two of the authors have significant statistical expertise.
Written informed consent was not required for this study because it is a systematic review of published studies.
Institutional Review Board approval was not required because it is a systematic review of published studies.
Study subjects or cohorts overlap
Some study subjects or cohorts have been previously reported in a technical report published in Norwegian by the Norwegian Institute of Public Health (PubMed: https://www.ncbi.nlm.nih.gov/pubmed/29553688).
Compared to the technical report in Norwegian, the submitted manuscript has been rewritten and updated with three more included studies.
• Systematic review
- 1.UNICEF (2013) Every child’s birth right: inequities and trends in birth registration. UNICEF, New YorkGoogle Scholar
- 2.EASO (2018) Practical guide on age asessment. Available from: https://www.easo.europa.eu/sites/default/files/easo-practical-guide-qualification-for-international-protection-2018.pdf. European Asylum Support Office
- 3.Demirjian A, Goldstein H, Tanner JM (1973) A new system of dental age assessment. Hum Biol 45:211–227Google Scholar
- 6.Dahlberg PS, Mosdøl A, Ding Y et al (2018) A systematic review of the agreement between chronological age and skeletal age based on the Greulich and Pyle atlas. Eur Radiol. https://doi.org/10.1007/s00330-018-5718-2
- 7.Higgins JPT, Green S (2011) Cochrane handbook for systematic reviews of interventions Version 5.1.0 [updated March 2011]. The Cochrane CollaborationGoogle Scholar
- 9.Rolseth V, Mosdøl A, Dahlberg PS et al (2017) Demirjians utviklingsstadier på visdomstenner for estimering av kronologisk alder: en systematisk oversikt (Demirjian’s Development Stages on Wisdom Teeth for Estimation of Chronological Age: A Systematic Review). Knowledge Centre for the Health Services at The Norwegian Institute of Public Health (NIPH), Oslo, Norway. Available from: https://www.fhi.no/en/publ/2017/demirjians-utviklingsstadier-pa-visdomstenner-for-estimering-av-kronologisk/
- 10.Bocquet-Appel JP, Masset C (1982) Farewell to paleodemography. J Hum Evol 11:321–333Google Scholar
- 11.Boldsen JL, Milner GR, Konigsberg LW, Wood JW (2002) Transition analysis: a new method for estimating age from skeletons. In: Hoppa RD, Vaupel JW (eds) Paleodemography: age distributions from skeletal samples. (Cambridge Studies in Biological and Evolutionary Anthropology). Cambridge University Press, Cambridge, pp 73–106Google Scholar
- 16.Elshehawi W, Alsaffar H, Roberts G, Lucas V, McDonald F, Camilleri S (2016) Dental age assessment of Maltese children and adolescents. Development of a reference dataset and comparison with a United Kingdom Caucasian reference dataset. J Forensic Leg Med 39:27–33Google Scholar
- 19.Johan NA, Khamis MF, Abdul Jamal NS, Ahmad B, Mahanani ES (2012) The variability of lower third molar development in Northeast Malaysian population with application to age estimation. J Forensic Odontostomatol 30:45–54Google Scholar
- 21.Karataş OH, Öztürk F, Dedeoğlu N, Çolak C, Altun O (2013) Radiographic evaluation of third-molar development in relation to the chronological age of Turkish children in the southwest Eastern Anatolia region. Forensic Sci Int 232:238.e231–238.e235Google Scholar
- 23.Lopez TT, Arruda CP, Rocha M, Rosin AS, Michel-Crosato E, Biazevic MG (2013) Estimating ages by third molars: stages of development in Brazilian young adults. J Forensic Leg Med 20:412–418Google Scholar
- 25.Nur B, Altunsoy M, Akkemik Ö, Ok E, Evcil MS (2015) Third-molar mineralisation and eruption correlated to chronologic age in Turkish children and adolescents. Aust J Forensic Sci 47:313–321Google Scholar
- 29.Prieto JL, Barbería E, Ortega R, Magaña C (2005) Evaluation of chronological age based on third molar development in the Spanish population. Int J Legal Med 119:349–354Google Scholar
- 30.Qing M, Qiu L, Gao Z, Bhandari K (2014) The chronological age estimation of third molar mineralisation of Han population in southwestern China. J Forensic Leg Med 24:24–27Google Scholar
- 31.Rougé-Maillart C, Franco A, Franco T, Jousset N (2011) Estimation of the age of 15-25 year-olds using Dermirjian’s dental technique. Study of a population from the West, France. Revue de Medecine Legale 2:117–124Google Scholar
- 34.Schmeling A, Garamendi PM, Prieto JL and Landa MI (2011) Forensic age estimation in unaccompanied minors and young living adults, forensic medicine - from old problems to new challenges. Prof. Duarte Nuno Vieira (Ed.), InTech. https://doi.org/10.5772/19261. Available from: https://www.intechopen.com/books/forensic-medicine-from-old-problems-to-new-challenges/forensic-age-estimation-in-unaccompanied-minors-and-young-living-adults
- 37.Bleka Ø, Wisløff T, Dahlberg PS, Rolseth V, Egeland T (2018) Advancing estimation of chronological age by utilizing available evidence based on two radiographical methods. Int J Legal Med. https://doi.org/10.1007/s00414-018-1848-y
- 38.Roberts GJ, McDonald F, Andiappan M, Lucas VS (2015) Dental age estimation (DAE): data management for tooth development stages including the third molar. Appropriate censoring of stage H, the final stage of tooth development. J Forensic Leg Med 36:177–184Google Scholar
- 42.Sironi E, Vuille J, Morling N, Taroni F (2017) On the Bayesian approach to forensic age estimation of living individuals. Forensic Sci Int. https://doi.org/10.1016/j.forsciint.2017.11.007
- 43.Sironi E, Pinchi V, Pradella F, Focardi M, Bozza S, Taroni F (2018) Bayesian networks of age estimation and classification based on dental evidence: a study on the third molar mineralisation. J Forensic Leg Med 55:23–32Google Scholar
- 44.Liversidge HM, Peariasamy K, Folayan MO et al (2017) A radiographic study of the mandibular third molar root development in different ethnic groups. J Forensic Odontostomatol 2:97–108Google Scholar