European Radiology

, Volume 29, Issue 5, pp 2311–2321 | Cite as

Age assessment by Demirjian’s development stages of the third molar: a systematic review

  • Veslemøy RolsethEmail author
  • Annhild Mosdøl
  • Pål Skage Dahlberg
  • Yunpeng Ding
  • Øyvind Bleka
  • Marianne Skjerven-Martinsen
  • Gyri Hval Straumann
  • Gerd Jorunn Møller Delaveris
  • Gunn Elisabeth Vist
Forensic Medicine



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.

Key Points

• 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.


Age determination by teeth Molar, third Odontogenesis Adolescent Young adult 



Chronological age


Prediction interval



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.

Informed consent

Written informed consent was not required for this study because it is a systematic review of published studies.

Ethical approval

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:

Compared to the technical report in Norwegian, the submitted manuscript has been rewritten and updated with three more included studies.


• Systematic review

Supplementary material

330_2018_5761_MOESM1_ESM.docx (101 kb)
ESM 1 (DOCX 101 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Veslemøy Rolseth
    • 1
    Email author
  • Annhild Mosdøl
    • 2
  • Pål Skage Dahlberg
    • 1
  • Yunpeng Ding
    • 2
  • Øyvind Bleka
    • 1
  • Marianne Skjerven-Martinsen
    • 1
  • Gyri Hval Straumann
    • 2
  • Gerd Jorunn Møller Delaveris
    • 1
  • Gunn Elisabeth Vist
    • 2
  1. 1.Department of Forensic SciencesOslo University HospitalOsloNorway
  2. 2.Division for health servicesNorwegian Institute of Public HealthOsloNorway

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