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Accuracy of the third molar maturity index in assessing the legal age of 18 years: a systematic review and meta-analysis

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Abstract

The age estimation is a complex procedure required in the daily practice of legal medicine. The maturity of third molars stands out by the age of 18 because these teeth are still in development. This systematic review aimed to assess the accuracy of the third molar maturity index (I 3M), proposed by Cameriere et al. (2008), in discriminating whether an individual is under or over 18 years. Seven electronic databases were screened: PubMed, Scopus, ISI Web of Science, Cochrane Library, LILACS, SIGLE, and CAPES. Eligible studies included an assessment of I 3M accuracy at the 0.08 cut-off value. The quality assessment was performed by using QUADAS 2. Three meta-analyses (MA) were accomplished: overall, one for males and another for females. From 2397 articles identified, 16 met the eligibility criteria. Of these, two showed high risk of bias, one in the reference standard domain and the other in the flow and timing domain. The percentage of individuals correctly classified ranged from 72.4 to 96.0%. The overall MA showed pooled sensitivity of 0.86 (0.84 to 0.87; p = 0.0000) and pooled specificity of 0.93 (0.92 to 0.94; p = 0.0000). The AUC (area under the summary receiver operator characteristics curve) and DOR (diagnostic odds ratio) values were, respectively, 0.9652 and 104.68, indicating an overall high discrimination effect. Separately, better results of accuracy were found for males. High heterogeneity was achieved for both sensibility (94.6%) and specificity (88.8%). We conclude that the I 3M is a suitable and useful method for estimating adulthood regarding forensic purposes, regardless of gender.

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References

  1. Yan J, Lou X, Xie L, Yu D, Shen G, Wang Y (2013) Assessment of dental age of children aged 3.5 to 16.9 years using Demirjian’s method: a meta-analysis based on 26 studies. PLoS One 8(12):e84672–e84672. https://doi.org/10.1371/journal.pone.0084672

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  2. Dardouri AAK, Cameriere R, De Luca S, Vanin S (2016) Third molar maturity index by measurements of open apices in a Libyan sample of living subjects. Forensic Sci Int 267:230.e1–230.e6. https://doi.org/10.1016/j.forsciint.2016.07.020

    Article  Google Scholar 

  3. Franklin D, Karkhanis S, Flavel A, Collini F, DeLuca S, Cameriere R (2016) Accuracy of a cut-off value based on the third molar index: validation in an Australian population. Forensic Sci Int 266:6–11. https://doi.org/10.1016/j.forsciint.2016.06.032

    Article  Google Scholar 

  4. Costa JJ, Montero J, Serrano S et al (2014) Accuracy in the legal age estimation according to the third molars mineralization among Mexicans and Columbians. Aten Primaria 46:165–175. https://doi.org/10.1016/S0212-6567(14)70086-1

    Article  PubMed  PubMed Central  Google Scholar 

  5. Deitos AR, Costa C, Michel-Crosato E, Galić I, Cameriere R, Biazevic MGH (2015) Age estimation among Brazilians: younger or older than 18? J Forensic Legal Med 33:111–115. https://doi.org/10.1016/j.jflm.2015.04.016

    Article  Google Scholar 

  6. Zelic K, Galic I, Nedeljkovic N, Jakovljevic A, Milosevic O, Djuric M, Cameriere R (2016) Accuracy of Cameriere’s third molar maturity index in assessing legal adulthood on Serbian population. Forensic Sci Int 259:127–132. https://doi.org/10.1016/j.forsciint.2015.12.032

    Article  PubMed  Google Scholar 

  7. Gulsahi A, De Luca S, Cehreli SB, Tirali RE, Cameriere R (2016) Accuracy of the third molar index for assessing the legal majority of 18 years in Turkish population. Forensic Sci Int 266:584.e1–584.e6. https://doi.org/10.1016/j.forsciint.2016.04.034

    Article  Google Scholar 

  8. De Luca S, Aguilar L, Rivera M, Palacio LAV, Riccomi G, Bestetti F, Cameriere R (2016) Accuracy of cut-off value by measurement of third molar index: study of a Colombian sample. Forensic Sci Int 261:160.e1–160.e5. https://doi.org/10.1016/j.forsciint.2016.01.026

    Article  Google Scholar 

  9. ICC-CPI (2014) Understanding the International Criminal Court. 49

  10. Schneider ÉM, Iglesias JR, Hallberg K, Kuperman MN (2014) Crimes against humanity: the role of international courts. PLoS One 9(6):4–10. https://doi.org/10.1371/journal.pone.0099064

    Article  CAS  Google Scholar 

  11. Dardouri AAK, Cameriere R, De Luca S, Vanin S (2016) Third molar maturity index by measurements of open apices in a Libyan sample of living subjects. J Forensic Sci 267:230.e1–230.e6. https://doi.org/10.1016/j.forsciint.2016.07.020

    Google Scholar 

  12. 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(2):379–390

    Article  CAS  PubMed  Google Scholar 

  13. Demirjian A, Goldstein H, Tanner JM (1973) A new system of dental age assessment. Hum Biol 45(2):211–227

    CAS  PubMed  Google Scholar 

  14. Demirjian A, Goldstein H (1976) New system for dental maturity based on seven and four teeth. Ann Hum Biol 3(5):411–421. https://doi.org/10.1080/03014467600001671

    Article  CAS  PubMed  Google Scholar 

  15. Moorrees CF, Fanning EA, Hunt EE (1963) Age variation of formation stages for ten permanent teeth. J Dent Res 42(6):1490–1502. https://doi.org/10.1177/00220345630420062701

    Article  CAS  PubMed  Google Scholar 

  16. Nicodemo RA, Moraes LC, Médici Filho E (1974) Chronological table of mineralization of permanent teeth among Brazilians. Rev da Fac Odontol São José dos Campos 3:55–56

    CAS  Google Scholar 

  17. Thevissen PW, Fieuws S, Willems G (2013) Third molar development: evaluation of nine tooth development registration techniques for age estimations. J Forensic Sci 58(2):393–397. https://doi.org/10.1111/1556-4029.12063

    Article  PubMed  Google Scholar 

  18. Thevissen PW, Fieuws S, Willems G (2011) Third molar development: measurements versus scores as age predictor. Arch Oral Biol 56(10):1035–1040. https://doi.org/10.1016/j.archoralbio.2011.04.008

    Article  CAS  PubMed  Google Scholar 

  19. Cameriere R, Ferrante L, De Angelis D, Scarpino F, Galli F (2008) The comparison between measurement of open apices of third molars and Demirjian stages to test chronological age of over 18 year olds in living subjects. Int J Legal Med 122(6):493–497. https://doi.org/10.1007/s00414-008-0279-6

    Article  CAS  PubMed  Google Scholar 

  20. Cameriere R, Santoro V, Roca R, Lozito P, Introna F, Cingolani M, Galić I, Ferrante L (2014) Assessment of legal adult age of 18 by measurement of open apices of the third molars: study on the Albanian sample. Forensic Sci Int 245c:205.e1–205.e5. https://doi.org/10.1016/j.forsciint.2014.10.013

    Article  Google Scholar 

  21. Galic I, Lauc T, Brkic H et al (2015) Cameriere’s third molar maturity index in assessing age of majority. Forensic Sci Int 252:191.e1-5

    Article  PubMed  Google Scholar 

  22. Maia LC, Antonio AG (2012) Systematic reviews in dental research. A guideline. J Clin Pediatr Dent 37(2):117–124. https://doi.org/10.17796/jcpd.37.2.h606137vj3826v61

    Article  PubMed  Google Scholar 

  23. Moses LE, Shapiro D, Littenberg B (1993) Combining independent studies of a diagnostic test into a summary ROC curve: data-analytic approaches and some additional considerations. Stat Med 12(14):1293–1316. https://doi.org/10.1002/sim.4780121403

    Article  CAS  PubMed  Google Scholar 

  24. Walter SD (2002) Properties of the summary receiver operating characteristic (SROC) curve for diagnostic test data. Stat Med 21(9):1237–1256. https://doi.org/10.1002/sim.1099

    Article  CAS  PubMed  Google Scholar 

  25. Jaeschke R, Guyatt GH, Sackett DL (1994) Users’ guides to the medical literature. III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? The evidence-based medicine working group. J Am Med Assoc 271(9):703–707. https://doi.org/10.1001/jama.1994.03510330081039

    Article  CAS  Google Scholar 

  26. Bossuyt PM, Davenport C, Deeks J, et al (2013) Chapter 11 interpreting results and drawing conclusions. In: Cochrane handbook for systematic reviews of diagnostic test version 0.9 accuracy. pp 1–31. Available from: http://srdta.cochrane.org/

  27. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. J Clin Epidemiol 62(10):1006–1012. https://doi.org/10.1016/j.jclinepi.2009.06.005

    Article  PubMed  Google Scholar 

  28. Cameriere R, Pacifici A, Viva S, Carbone D, Pacifici L, Polimeni A (2014) Adult or not? Accuracy of Cameriere’s cut-off value for third molar in assessing 18 years of age for legal purposes. Minerva Stomatol 63(9):283–294

    CAS  PubMed  Google Scholar 

  29. Cavric J, Galic I, Vodanovic M et al (2016) Third molar maturity index (I3M) for assessing age of majority in a black African population in Botswana. Int J Legal Med 130(4):1109–1120. https://doi.org/10.1007/s00414-016-1344-1

    Article  PubMed  Google Scholar 

  30. De Luca S, Biagi R, Begnoni G, Farronato G, Cingolani M, Merelli V, Ferrante L, Cameriere R (2014) Accuracy of Cameriere’s cut-off value for third molar in assessing 18 years of age. Forensic Sci Int 235:102.e1–102.e6. https://doi.org/10.1016/j.forsciint.2013.10.036

    Article  Google Scholar 

  31. AlQahtani S, Kawthar A, AlAraik A, AlShalan A (2017) Third molar cut-off value in assessing the legal age of 18 in Saudi population. Forensic Sci Int 272:64–67. https://doi.org/10.1016/j.forsciint.2017.01.004

    Article  PubMed  Google Scholar 

  32. Martins HM (2015) "Avaliação da idade cronológica em adolescentes e adultos jovens por meio da abertura do ápice dentário". Dissertation, University of Campinas

  33. Quispe Lizarbe RJ, Solís Adrianzén C, Quezada-Márquez MM, Galić I, Cameriere R (2017) Demirjian’s stages and Cameriere’s third molar maturity index to estimate legal adult age in Peruvian population. Legal Med 25:59–65. https://doi.org/10.1016/j.legalmed.2017.01.003

    Article  PubMed  Google Scholar 

  34. Balla SB, Galic I, Karunakar P et al (2017) Validation of third molar maturity index (I3M) for discrimination of juvenile/adult status in South Indian population. J Forensic Legal Med 49:2–7. https://doi.org/10.1016/j.jflm.2017.05.003

    Article  Google Scholar 

  35. Cavric J, Vodanovic M, Marusic A, Galic I (2016) Time of mineralization of permanent teeth in children and adolescents in Gaborone, Botswana. Ann Anat 203:24–32. https://doi.org/10.1016/j.aanat.2015.08.001

    Article  PubMed  Google Scholar 

  36. De Luca S, Pacifici A, Pacifici L, Polimeni A, Fischetto SG, Velandia Palacio LA, Vanin S, Cameriere R (2016) Third molar development by measurements of open apices in an Italian sample of living subjects. J Forensic Legal Med 38:36–42. https://doi.org/10.1016/j.jflm.2015.11.007

    Article  Google Scholar 

  37. Timme M, Timme WH, Olze A, Ottow C, Ribbecke S, Pfeiffer H, Dettmeyer R, Schmeling A (2017) Dental age estimation in the living after completion of third molar mineralization: new data for Gustafson’s criteria. Int J Legal Med 131(2):569–577. https://doi.org/10.1007/s00414-016-1492-3

    Article  CAS  PubMed  Google Scholar 

  38. Trpkova B, Major P, Prasad N, Nebbe B (1997) Cephalometric landmarks identification and reproducibility: a meta analysis. Am J Orthod Dentofac Orthop 112(2):165–170. https://doi.org/10.1016/S0889-5406(97)70242-7

    Article  CAS  Google Scholar 

  39. Miloro M, Borba AM, Ribeiro-Junior O, Naclério-Homem MG, Jungner M (2014) Is there consistency in cephalometric landmark identification amongst oral and maxillofacial surgeons? Int J Oral Maxillofac Surg 43(4):445–453. https://doi.org/10.1016/j.ijom.2013.08.007

    Article  CAS  PubMed  Google Scholar 

  40. Cummins DM, Bishara SE, Jakobsen JR (1995) A computer assisted photogrammetric analysis of soft tissue changes after orthodontic treatment: part II results. Am J Orthod Dentofac Orthop 108(1):38–47. https://doi.org/10.1016/S0889-5406(95)70064-1

    Article  CAS  Google Scholar 

  41. Huedo-Medina TB, Sánchez-Meca J, Marín-Martínez F, Botella J (2006) Assessing heterogeneity in meta-analysis: Q statistic or I2 index? Psychol Methods 11(2):193–206. https://doi.org/10.1037/1082-989X.11.2.193

    Article  PubMed  Google Scholar 

  42. Higgins JPT, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JAC, Cochrane Bias Methods Group, Cochrane Statistical Methods Group (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343(oct18 2):d5928–d5928. https://doi.org/10.1136/bmj.d5928

    Article  PubMed  PubMed Central  Google Scholar 

  43. Schroeder M, Reis A, Luque-Martinez I, Loguercio AD, Masterson D, Maia LC (2015) Effect of enamel bevel on retention of cervical composite resin restorations: a systematic review and meta-analysis. J Dent 43(7):777–788. https://doi.org/10.1016/j.jdent.2015.02.017

    Article  CAS  PubMed  Google Scholar 

  44. Higgins JPT, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21(11):1539–1558. https://doi.org/10.1002/sim.1186

    Article  PubMed  Google Scholar 

  45. Olze A, Bilang D, Schmidt S, Wernecke KD, Geserick G, Schmeling A (2005) Validation of common classification systems for assessing the mineralization of third molars. Int J Legal Med 119(1):22–26. https://doi.org/10.1007/s00414-004-0489-5

    Article  PubMed  Google Scholar 

  46. Liversidge HM, Marsden PH (2010) Estimating age and the likelihood of having attained 18 years of age using mandibular third molars. Br Dent J 209(8):E13–E13. https://doi.org/10.1038/sj.bdj.2010.976

    Article  CAS  PubMed  Google Scholar 

  47. Thevissen PW, Pittayapat P, Fieuws S, Willems G (2009) Estimating age of majority on third molars developmental stages in young adults from Thailand using a modified scoring technique. J Forensic Sci 54(2):428–432. https://doi.org/10.1111/j.1556-4029.2008.00961.x

    Article  PubMed  Google Scholar 

  48. Liversidge HM (2008) Timing of human mandibular third molar formation. Ann Hum Biol 35(3):294–321. https://doi.org/10.1080/03014460801971445

    Article  CAS  PubMed  Google Scholar 

  49. Olze A, van Niekerk P, Ishikawa T, Zhu BL, Schulz R, Maeda H, Schmeling A (2007) Comparative study on the effect of ethnicity on wisdom tooth eruption. Int J Legal Med 121(6):445–448. https://doi.org/10.1007/s00414-007-0171-9

    Article  CAS  PubMed  Google Scholar 

  50. Higgins JP, Green S (n.d.) Cochrane handbook for systematic reviews of interventions. Cochrane Book Series. http://training.cochrane.org/handbook. Accessed 10 November 2016, DOI: https://doi.org/10.1002/9780470712184

  51. Singh N, Grover N, Puri N, Singh S (2014) Age estimation from physiological changes of teeth : a reliable age marker ? J Forensic Dent Sci 6(2):113–121. https://doi.org/10.4103/0975-1475.132541

    Article  PubMed  PubMed Central  Google Scholar 

  52. Bajpai M, Pardhe N, Kumar M, Agrawal SA Comparative evaluation of Gustafson’s formula and new formula for age estimation in India—a forensic study. Prague Med Rep 116:203–209

  53. Olze A, Hertel J, Schulz R, Wierer T, Schmeling A (2012) Radiographic evaluation of Gustafson’s criteria for the purpose of forensic age diagnostics. Int J Legal Med 126(4):615–621. https://doi.org/10.1007/s00414-012-0701-y

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors of this study would like to thank the following authors who kindly provided information not available in their full texts: Alexandre Raphael Deitos and Stefano De Luca.

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Author notes

  1. Bianca Marques Santiago, Leopoldina Almeida, and Lucianne Cople Maia contributed equally to this work. They are Joint Senior Authors.

    Yuri Wanderley Cavalcanti and Marcela Baraúna Magno also contributed equally to this work.

Authors and Affiliations

  1. Department of Clinics and Social Dentistry, Federal University of Paraíba, Campus I, University City, João Pessoa, Paraíba, 58051-900, Brazil

    Bianca Marques Santiago, Leopoldina Almeida & Yuri Wanderley Cavalcanti

  2. Department of Forensic Medicine and Dentistry, Scientific Policy Institute, Antônio Teotônio Street, Cristo Redentor, João Pessoa, Paraíba, 58071-620, Brazil

    Bianca Marques Santiago

  3. Department of Pediatric Dentistry and Orthodontics, Federal University of Rio de Janeiro, Professor Rodolpho Paulo Rocco Street, 325, University City, Rio de Janeiro, 21941-617, Brazil

    Marcela Baraúna Magno & Lucianne Cople Maia

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  1. Bianca Marques Santiago
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  2. Leopoldina Almeida
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Correspondence to Bianca Marques Santiago.

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Santiago, B.M., Almeida, L., Cavalcanti, Y.W. et al. Accuracy of the third molar maturity index in assessing the legal age of 18 years: a systematic review and meta-analysis. Int J Legal Med 132, 1167–1184 (2018). https://doi.org/10.1007/s00414-017-1766-4

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