Abstract
Objectives
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.
Methods
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.
Results
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.
Conclusion
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.
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Abbreviations
- CA:
-
Chronological age
- PI:
-
Prediction interval
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Acknowledgements
The authors thank Marit Johansen for peer review of the literature search strategy.
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The scientific guarantor of this publication is the last author, Gunn Elisabeth Vist, Division for Health Services, Norwegian Institute of Public Health, Norway.
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Statistics and biometry
Two of the authors have significant statistical expertise.
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Written informed consent was not required for this study because it is a systematic review of published studies.
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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.
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Rolseth, V., Mosdøl, A., Dahlberg, P.S. et al. Age assessment by Demirjian’s development stages of the third molar: a systematic review. Eur Radiol 29, 2311–2321 (2019). https://doi.org/10.1007/s00330-018-5761-z
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DOI: https://doi.org/10.1007/s00330-018-5761-z