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Age assessment based on third molar mineralisation

An epidemiological-radiological study on a Central-European population

Altersbestimmung anhand der Weisheitszahnmineralisation

Eine epidemiologisch-radiologische Studie an einem mitteleuropäischen Probandengut

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Abstract

Purpose

The method published in 1973 by Demirjian et al. to assess age based on the mineralisation stage of permanent teeth is standard practice in forensic and orthodontic diagnostics. From age 14 onwards, however, this method is only applicable to third molars. No current epidemiological data on third molar mineralisation are available for Caucasian Central-Europeans. Thus, a method for assessing age in this population based on third molar mineralisation is presented, taking into account possible topographic and gender-specific differences.

Methods

The study included 486 Caucasian Central-European orthodontic patients (9–24 years) with unaffected dental development. In an anonymized, randomized, and blinded manner, one orthopantomogram of each patient at either start, mid or end of treatment was visually analysed regarding the mineralisation stage of the third molars according to the method by Demirjian et al. Corresponding topographic and gender-specific point scores were determined and added to form a dental maturity score. Prediction equations for age assessment were derived by linear regression analysis with chronological age and checked for reliability within the study population.

Results

Mineralisation of the lower third molars was slower than mineralisation of the upper third molars, whereas no jaw-side-specific differences were detected. Gender-specific differences were relatively small, but girls reached mineralisation stage C earlier than boys, whereas boys showed an accelerated mineralisation between the ages of 15 and 16.

Conclusions

The global equation generated by regression analysis (age = −1.103 + 0.268 × dental maturity score 18 + 28 + 38 + 48) is sufficiently accurate and reliable for clinical use. Age assessment only based on either maxilla or mandible also shows good prognostic reliability.

Zusammenfassung

Purpose

Die von Demirjian et al. in 1973 beschriebene Methode, das Alter anhand des Mineralisationsstadiums der permanenten Dentition zu bestimmen, hat sich in der forensischen und kieferorthopädischen Diagnostik als Standardverfahren etabliert. Jenseits des 14. Lebensjahres ist dies jedoch nur anhand des Mineralisationsgrades der Weisheitszähne möglich. Aufgrund fehlender epidemiologischer Daten bezüglich der Weisheitszahnmineralisation in einer mitteleuropäisch-kaukasischen Population sollte unter Berücksichtigung möglicher topographischer und geschlechtsspezifischer Unterschiede mittels Regression ein Verfahren zur Altersbestimmung anhand der Weisheitszähne bei Mitteleuropäern entwickelt werden.

Methoden

Von den 486 in die Studie eingeschlossenen, kieferorthopädisch behandelten, kaukasisch-mitteleuropäischen Probanden zwischen 9 und 24 Jahren mit unbeeinflusster Zahnentwicklung wurde jeweils anonymisiert, randomisiert und verblindet das diagnostische Orthopantomogramm des Anfangs-, des Zwischen- oder des Endbefundes ausgewertet. Die Mineralisationsstadien der Weisheitszähne wurden nach der Skala von Demirjian et al. visuell-optisch bestimmt. Nach Ermittlung korrespondierender topographischer und geschlechtsspezifischer Punktwerte und Bildung eines Reife-Scores durch Addition erfolgte eine lineare Regressionsanalyse mit dem chronologischen Alter der Probanden, um Prognosegleichungen für die Altersbestimmung zu erstellen, die anschließend am vorliegenden Probandenkollektiv auf ihre Reliabilität geprüft wurden.

Ergebnisse

Die Mineralisation der unteren Weisheitszähne war gegenüber der Mineralisation der oberen verzögert; seitenspezifische Unterschiede wurden nicht festgestellt. Geschlechtsspezifische Unterschiede waren gering ausgeprägt, bei Mädchen wurde jedoch das Mineralisationsstadium C früher erreicht, während Jungen zwischen 15 und 16 Jahren eine Akzeleration der Mineralisation zeigten.

Schlussfolgerungen

Die mittels Regressionsanalyse erstellte globale Regressionsgleichung Alter = −1.103 + 0.268 x Summenreifepunktwert (Reife-Score) 18 + 28 + 38 + 48 erwies sich als ausreichend präzise und reliabel für die klinische Anwendung. Auch eine Altersbestimmung unter alleiniger Beurteilung der Weisheitszähne von Ober- bzw. Unterkiefer besitzt eine gute prognostische Reliabilität.

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Authors and Affiliations

  1. Department of Orthodontics, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany

    Elisabeth Hofmann, Matthias Robold, Peter Proff & Christian Kirschneck

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  1. Elisabeth Hofmann
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  2. Matthias Robold
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Correspondence to Christian Kirschneck.

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E Hofmann, M. Robold, P. Proff, and C. Kirschneck report no financial or other conflict of interest relevant to this article, which is the intellectual property of the authors. Furthermore, no part of this article has been published before or is considered for publication elsewhere. The results, however, were used within a scientific qualification work of the author Matthias Robold (2015) before. It has been approved by all authors and the affiliated institution.

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No funding was received for this study.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals.

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Christian Kirschneck, DDS

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Hofmann, E., Robold, M., Proff, P. et al. Age assessment based on third molar mineralisation. J Orofac Orthop 78, 97–111 (2017). https://doi.org/10.1007/s00056-016-0063-z

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