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

  • Forensic Medicine
  • Published:
European Radiology Aims and scope Submit manuscript

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

References

  1. UNICEF (2013) Every child’s birth right: inequities and trends in birth registration. UNICEF, New York

    Google 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 45:211–227

    CAS  PubMed  Google Scholar 

  4. Moorrees CFA, Fanning EA, Hunt EE Jr (1963) Age variation of formation stages for ten permanent teeth. J Dent Res 42:1490–1502

    Article  CAS  PubMed  Google Scholar 

  5. Mincer HH, Harris EF, Berryman HE (1993) The A.B.F.O. study of third molar development and its use as an estimator of chronological age. J Forensic Sci 38:379–390

    Article  CAS  PubMed  Google 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 Collaboration

  8. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535

    Article  PubMed  PubMed Central  Google 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 11:321–333

  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 73–106

  12. Chaumoitre K, Saliba-Serre B, Adalian P, Signoli M, Leonetti G, Panuel M (2017) Forensic use of the Greulich and Pyle atlas: prediction intervals and relevance. Eur Radiol 27:1032–1043

    Article  CAS  PubMed  Google Scholar 

  13. Lee SH, Lee JY, Park HK, Kim YK (2009) Development of third molars in Korean juveniles and adolescents. Forensic Sci Int 188:107–111

    Article  PubMed  Google Scholar 

  14. Boonpitaksathit T, Hunt N, Roberts GJ, Petrie A, Lucas VS (2011) Dental age assessment of adolescents and emerging adults in United Kingdom Caucasians using censored data for stage H of third molar roots. Eur J Orthod 33:503–508

    Article  PubMed  Google Scholar 

  15. Cavrić J, Vodanović M, Marušić A, Galić I (2016) Time of mineralisation of permanent teeth in children and adolescents in Gaborone, Botswana. Ann Anat 203:24–32

    Article  PubMed  Google 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 39:27–33

  17. Guo YC, Lin XW, Zhang WT et al (2015) Chronology of third molar mineralisation in a northern Chinese population. Rechtsmedizin 25:34–39

    Article  CAS  Google Scholar 

  18. Guo YC, Yan CX, Lin XW et al (2014) The influence of impaction to the third molar mineralisation in northwestern Chinese population. Int J Legal Med 128:659–665

    Article  PubMed  Google 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 30:45–54

    CAS  PubMed  PubMed Central  Google Scholar 

  20. Karadayi B, Kaya A, Afsin H, Ozaslan A, Çetin G (2015) The usage of third molars to determine legally relevant age thresholds in Turkey. Aust J Forensic Sci 47:275–282

    Article  Google 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.e235

  22. Li G, Ren J, Zhao S et al (2012) Dental age estimation from the developmental stage of the third molars in western Chinese population. Forensic Sci Int 219:158–164

    Article  PubMed  Google 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 20:412–418

  24. Meinl A, Tangl S, Pernicka E, Fenes C, Watzek G (2007) On the applicability of secondary dentin formation to radiological age estimation in young adults. J Forensic Sci 52:438–441

    Article  PubMed  Google 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 47:313–321

  26. Olze A, van Niekerk P, Schmidt S et al (2006) Studies on the progress of third-molar mineralisation in a Black African population. Homo 57:209–217

    Article  CAS  PubMed  Google Scholar 

  27. Olze A, Pynn BR, Kraul V et al (2010) Studies on the chronology of third molar mineralisation in First Nations people of Canada. Int J Legal Med 124:433–437

    Article  PubMed  Google Scholar 

  28. Olze A, van Niekerk P, Schulz R, Ribbecke S, Schmeling A (2012) The influence of impaction on the rate of third molar mineralisation in male black Africans. Int J Legal Med 126:869–874

    Article  PubMed  Google 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 119:349–354

  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 24:24–27

  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 2:117–124

  32. Zandi M, Shokri A, Malekzadeh H, Amini P, Shafiey P (2015) Evaluation of third molar development and its relation to chronological age: a panoramic radiographic study. Oral Maxillofac Surg 19:183–189

    Article  PubMed  Google Scholar 

  33. Zeng DL, Wu ZL, Cui MY (2010) Chronological age estimation of third molar mineralisation of Han in southern China. Int J Legal Med 124:119–123

    Article  PubMed  Google 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

  35. Liversidge HM, Smith BH, Maber M (2010) Bias and accuracy of age estimation using developing teeth in 946 children. Am J Phys Anthropol 143:545–554

    Article  PubMed  Google Scholar 

  36. Liversidge HM (2012) The assessment and interpretation of Demirjian, Goldstein and Tanner’s dental maturity. Ann Hum Biol 39:412–431

    Article  PubMed  Google Scholar 

  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 36:177–184

  39. 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

    Article  CAS  PubMed  Google Scholar 

  40. Konigsberg LW, Herrmann NP, Wescott DJ, Kimmerle EH (2008) Estimation and evidence in forensic anthropology: age-at-death. J Forensic Sci 53:541–557

    Article  PubMed  Google Scholar 

  41. Thevissen PW, Fieuws S, Willems G (2010) Human dental age estimation using third molar developmental stages: does a Bayesian approach outperform regression models to discriminate between juveniles and adults? Int J Legal Med 124:35–42

    Article  CAS  PubMed  Google 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 55:23–32

  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 2:97–108

    CAS  Google Scholar 

  45. Tangmose S, Thevissen P, Lynnerup N, Willems G, Boldsen J (2015) Age estimation in the living: transition analysis on developing third molars. Forensic Sci Int 257:512.e511–512.e517

    Article  Google Scholar 

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Acknowledgements

The authors thank Marit Johansen for peer review of the literature search strategy.

Funding

The authors state that this work has not received any funding.

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Corresponding author

Correspondence to Veslemøy Rolseth.

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Guarantor

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: 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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• Systematic review

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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

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