International Journal of Legal Medicine

, Volume 132, Issue 4, pp 1167–1184 | Cite as

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

  • Bianca Marques Santiago
  • Leopoldina Almeida
  • Yuri Wanderley Cavalcanti
  • Marcela Baraúna Magno
  • Lucianne Cople Maia
Original Article


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.


Age determination by teeth Forensic dentistry Legal age Third molar Systematic review 



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.


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

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Bianca Marques Santiago
    • 1
    • 2
  • Leopoldina Almeida
    • 1
  • Yuri Wanderley Cavalcanti
    • 1
  • Marcela Baraúna Magno
    • 3
  • Lucianne Cople Maia
    • 3
  1. 1.Department of Clinics and Social DentistryFederal University of Paraíba, Campus IJoão PessoaBrazil
  2. 2.Department of Forensic Medicine and DentistryScientific Policy InstituteJoão PessoaBrazil
  3. 3.Department of Pediatric Dentistry and OrthodonticsFederal University of Rio de JaneiroRio de JaneiroBrazil

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