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Third molar maturity index (I3M) assessment according to different geographical zones: a large multi-ethnic study sample

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Abstract

Identification of living undocumented individuals highlights the need for accurate, precise, and reproducible age estimation methods, especially in those cases involving minors. However, when their country of origin is unknown, or it can be only roughly estimated, it is extremely difficult to apply assessment policies, procedures, and practices that are accurate and child-sensitive. The main aim of this research is to optimize the correct classification of adults and minors by establishing new cut-off values for four different continents (Africa, America, Asia, and Europe). For this purpose, a vast sample of 10,701 orthopantomographs (OPTs) from four continents was evaluated. For determination and subsequent validation of the new third molar maturity index (I3M) cut-off values by world regions, a cross-validation by holdout method was used and contingency tables (confusion matrices) were generated. The lower third molar maturity indexes, from both left and right side (I3ML and I3MR) and the combination of both sides (I3ML_I3MR) were calculated. The new cut-off values, that aim to differentiate between a minor and an adult, with more than 74.00% accuracy for all populations were as follows (I3ML; I3MR; I3ML_I3MR, respectively): Africa = (0.10; 0.10; 0.10), America = (0.10; 0.09; 0.09), Asia = (0.15; 0.17; 0.14), and Europe = (0.09; 0.09; 0.09). The higher sensitivity (Se) was detected for the I3ML for male African people (91%) and the higher specificity (Sp) of all the parameters (I3ML; I3MR; I3ML_I3MR) for Europeans both male and female (> 91%). The original cut-off value (0.08) is still useful, especially in discriminating individuals younger than 18 years old which is the goal of the forensic methods used for justice.

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Data availability

The data that support the findings of this study are available on request from the corresponding author, [SDL]. The data are not publicly available due to [restrictions e.g. their containing information that could compromise the privacy of research participants].

Abbreviations

Acc:

Accuracy

ICC:

Intraclass correlation coefficient

I 3M :

Third molar maturity index

I 3ML:

Left Third molar maturity index

I3MR:

Right Third molar maturity index

I 3M L_I 3M R :

Combined (left + right) third molar maturity index

LR + :

Positive likelihood

LR − :

Negative likelihood

OPTs:

Orthopantomographs

PV + :

Positive predictive value

PV − :

Negative predictive value

Se:

Sensitivity

Sp:

Specificity

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Acknowledgements

The authors would like to thank Adriana Santos, Ana Rodrigues, and Rui Santos, researchers from the Portuguese Institution CEAUL, under FCT — Fundação para a Ciência e a Tecnologia and the project UIDB/00006/2020, and the Clinic of Dentistry at the Universidad Científica del Sur (Perú).

Funding

Inês Oliveira-Santos is supported by a FCT-Fundação para a Ciência e Tecnologia grant (SFRH/BD/139158/2018).

This research study was conducted retrospectively from OPTs obtained for clinical purposes. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Author information

Authors and Affiliations

  1. Department of Orthodontics and Dentofacial Orthopaedics, University of Bern, Bern, Switzerland

    Nikolaos Angelakopoulos

  2. AgEstimation Project, Department of Medicine and Health Sciences “Vincenzo Tiberio,” University of Molise, Campobasso, Italy

    Nikolaos Angelakopoulos, Stefano De Luca, Sudheer B. Balla, Ayse Gulsahi, Ivan Galić & Roberto Cameriere

  3. Panacea Cooperative Research S. Coop, Ponferrada, Spain

    Stefano De Luca

  4. Centre for Functional Ecology, Laboratory of Forensic Anthropology, Department of Life Sciences, University of Coimbra, Coimbra, Portugal

    Inês Oliveira-Santos

  5. Postgraduate Program in Dentistry, Universidade Federal da Paraíba, Joao Pessoa, , Paraiba, Brazil

    Isabella Lima Arrais Ribeiro

  6. Department of Law, Institute of Legal Medicine, University of Macerata, Macerata, Italy

    Ilenia Bianchi

  7. Department of Forensic Odontology, Panineeya Institute of Dental Sciences and Research Center, Hyderabad, Telangana, India

    Sudheer B. Balla

  8. Department of Orthodontics, Tokat Gaziosmanpaşa University, Tokat, Turkey

    Hatice Cansu Kis

  9. Instituto Nacional de Patología “Dr. Sergio Sarita Valdez,”, Santo Domingo, Dominican Republic

    Lourdes Gómez Jiménez

  10. Department of Forensic Medicine, I.M. Sechenov First Moscow State Medical University, Moscow, Russia

    Galina Zolotenkova

  11. Centre for Oral & Maxillofacial Diagnostics and Medicine Studies, Faculty of Dentistry, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia

    Mohd Yusmiaidil Putera Yusof

  12. Department of Dental Morphology With Dental Anthropology and Forensics, Faculty of Dentistry, University of Sarajevo, Sarajevo, Bosnia and Herzegovina

    Aida Hadzić Selmanagić

  13. Department of Forensic Medicine and Toxicology, Seth GS Medical College and KEM Hospital, Mumbai, India

    Hemlata Pandey

  14. Facultade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal

    Palmela C. Pereira

  15. Postgraduate Program in Dentistry, Universidade Federal da Paraíba, Joao Pessoa, Paraiba, Brazil

    Johnys Berton Medeiros da Nóbrega

  16. Department of Oral Medicine and Periodontology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka

    Hettiarachchi Kalani

  17. Department of Forensic Odontology, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia

    Sylvia M. Mieke

  18. Division of Forensic Odontology and Disaster Oral Medicine, Department of Forensic Science, Iwate Medical University, Morioka, Iwate, Japan

    Akiko Kumagai

  19. Dentomaxillofacial Radiology Department, Faculty of Dentistry, Baskent University, Ankara, Turkey

    Ayse Gulsahi

  20. Laboratory of Anthropology, Institute of Anatomy, School of Medicine, University of Belgrade, Belgrade, Serbia

    Ksenija Zelić

  21. Clinic for Orthodontics, School of Dental Medicine, University of Belgrade, Belgrade, Serbia

    Nemanja Marinković

  22. Department of Orthodontics, Faculty of Medicine Alma Mater Europaea, University of Pristina, Campus Rezonanca, Pristina, Kosovo

    Jeta Kelmendi

  23. Department of Oral Surgery, School of Medicine, University of Split, Split, Croatia

    Ivan Galić

  24. Forensic Odontologist, Department of Medicine and Health Sciences “Vincenzo Tiberio,” University of Molise, Campobasso, Italy

    Israel Soriano Vázquez

  25. Department of Surgical Sciences, Section of Dentistry, University of Cagliari, Cagliari, Italy

    Enrico Spinas

  26. Forensic Dentistry, Scientific University of the South, Lima, Peru

    Ymelda Wendy Velezmoro-Montes

  27. Beirut, Lebanon

    Maria Moukarzel

  28. Departamento de Patología Y Medicina Oral, Facultad de Odontología, Universidad de Chile, Santiago, Chile

    Jorge Pinares Toledo

  29. Escuela de Odontología, Facultad de Medicina, Universidad Católica de Chile, Santiago, Chile

    Jorge Pinares Toledo

  30. Faculty of Medicine, Mansoura University, Mansoura, Egypt

    Amal Abd El-Salam El-Bakary

Authors
  1. Nikolaos Angelakopoulos
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  2. Stefano De Luca
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  3. Inês Oliveira-Santos
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  4. Isabella Lima Arrais Ribeiro
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  6. Sudheer B. Balla
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  7. Hatice Cansu Kis
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  8. Lourdes Gómez Jiménez
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  9. Galina Zolotenkova
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  10. Mohd Yusmiaidil Putera Yusof
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  11. Aida Hadzić Selmanagić
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  12. Hemlata Pandey
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  13. Palmela C. Pereira
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  14. Johnys Berton Medeiros da Nóbrega
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  15. Hettiarachchi Kalani
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  16. Sylvia M. Mieke
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  17. Akiko Kumagai
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  18. Ayse Gulsahi
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  19. Ksenija Zelić
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  20. Nemanja Marinković
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  21. Jeta Kelmendi
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  22. Ivan Galić
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  23. Israel Soriano Vázquez
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  24. Enrico Spinas
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  25. Ymelda Wendy Velezmoro-Montes
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  26. Maria Moukarzel
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  27. Jorge Pinares Toledo
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  28. Amal Abd El-Salam El-Bakary
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  29. Roberto Cameriere
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Corresponding author

Correspondence to Stefano De Luca.

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According to the journal’s submission guidelines, an informed consent to participate in the study is not necessary for images such as x-rays to which the subjects had already consented to undergo and conserve for other reasons of a clinical nature.

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Angelakopoulos, N., De Luca, S., Oliveira-Santos, I. et al. Third molar maturity index (I3M) assessment according to different geographical zones: a large multi-ethnic study sample. Int J Legal Med 137, 403–425 (2023). https://doi.org/10.1007/s00414-022-02930-x

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  • DOI: https://doi.org/10.1007/s00414-022-02930-x

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