Advertisement

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
  • 189 Downloads

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.

Keywords

Age determination by teeth Molar, third Odontogenesis Adolescent Young adult 

Abbreviations

CA

Chronological age

PI

Prediction interval

Notes

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.

Compliance with ethical standards

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.

Methodology

• Systematic review

Supplementary material

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

References

  1. 1.
    UNICEF (2013) Every child’s birth right: inequities and trends in birth registration. UNICEF, New YorkGoogle Scholar
  2. 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. 3.
    Demirjian A, Goldstein H, Tanner JM (1973) A new system of dental age assessment. Hum Biol 45:211–227Google Scholar
  4. 4.
    Moorrees CFA, Fanning EA, Hunt EE Jr (1963) Age variation of formation stages for ten permanent teeth. J Dent Res 42:1490–1502CrossRefGoogle Scholar
  5. 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 38:379–390CrossRefGoogle Scholar
  6. 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. 7.
    Higgins JPT, Green S (2011) Cochrane handbook for systematic reviews of interventions Version 5.1.0 [updated March 2011]. The Cochrane CollaborationGoogle Scholar
  8. 8.
    Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535CrossRefGoogle Scholar
  9. 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. 10.
    Bocquet-Appel JP, Masset C (1982) Farewell to paleodemography. J Hum Evol 11:321–333Google Scholar
  11. 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 73–106Google Scholar
  12. 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 27:1032–1043CrossRefGoogle Scholar
  13. 13.
    Lee SH, Lee JY, Park HK, Kim YK (2009) Development of third molars in Korean juveniles and adolescents. Forensic Sci Int 188:107–111CrossRefGoogle Scholar
  14. 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 33:503–508CrossRefGoogle Scholar
  15. 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 203:24–32CrossRefGoogle Scholar
  16. 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 39:27–33Google Scholar
  17. 17.
    Guo YC, Lin XW, Zhang WT et al (2015) Chronology of third molar mineralisation in a northern Chinese population. Rechtsmedizin 25:34–39CrossRefGoogle Scholar
  18. 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 128:659–665CrossRefGoogle Scholar
  19. 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 30:45–54Google Scholar
  20. 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 47:275–282CrossRefGoogle Scholar
  21. 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.e235Google Scholar
  22. 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 219:158–164CrossRefGoogle Scholar
  23. 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 20:412–418Google Scholar
  24. 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 52:438–441CrossRefGoogle Scholar
  25. 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 47:313–321Google Scholar
  26. 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 57:209–217CrossRefGoogle Scholar
  27. 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 124:433–437CrossRefGoogle Scholar
  28. 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 126:869–874CrossRefGoogle Scholar
  29. 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 119:349–354Google Scholar
  30. 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 24:24–27Google Scholar
  31. 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 2:117–124Google Scholar
  32. 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 19:183–189CrossRefGoogle Scholar
  33. 33.
    Zeng DL, Wu ZL, Cui MY (2010) Chronological age estimation of third molar mineralisation of Han in southern China. Int J Legal Med 124:119–123CrossRefGoogle Scholar
  34. 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. 35.
    Liversidge HM, Smith BH, Maber M (2010) Bias and accuracy of age estimation using developing teeth in 946 children. Am J Phys Anthropol 143:545–554CrossRefGoogle Scholar
  36. 36.
    Liversidge HM (2012) The assessment and interpretation of Demirjian, Goldstein and Tanner’s dental maturity. Ann Hum Biol 39:412–431CrossRefGoogle Scholar
  37. 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. 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 36:177–184Google Scholar
  39. 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 123:465CrossRefGoogle Scholar
  40. 40.
    Konigsberg LW, Herrmann NP, Wescott DJ, Kimmerle EH (2008) Estimation and evidence in forensic anthropology: age-at-death. J Forensic Sci 53:541–557CrossRefGoogle Scholar
  41. 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 124:35–42CrossRefGoogle Scholar
  42. 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. 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 55:23–32Google Scholar
  44. 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 2:97–108Google Scholar
  45. 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.e517CrossRefGoogle Scholar

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

Personalised recommendations