Skip to main content

Evaluation of the effect of impaction on the mineralization of mandibular third molars and forensic age estimation in a sample of south Indian children

Abstract

Assessment of third molar mineralization is a basic forensic odontological method available for age estimation in children and adolescents. Due to their protracted development into the late adolescence, their development has become the subject of interest and acquired great forensic importance. It is clearly evident in the literature that impaction factor has an influence on the rate of maturation of the third molars. In this regard, the present study was undertaken to test the relationship between impaction and its concomitant effect on the mineralization of the third molar and forensic age estimation. A total of 520 digital orthopantomograms (OPG) of 260 males and 260 females of south Indian origin were assessed retrospectively. Maturation of the third molars (I3M) was assessed using the method of Cameriere et al. (Int J Leg Med 122 (6):493–497, 2008). Impaction status was determined according to the position of lower right and left third molars in relation to the long axis of the second molars. Out of the total sample, 68.1% of lower left third molars and 71.2% of lower right molars were impacted. Statistical measures for I3M were calculated in the males and females for both impacted and non-impacted third molars. It was ascertained that the mean age and I3M values were higher in impacted third molars, indicating the slower rate of maturation than non-impacted ones. The sensitivity and specificity of the test (I3M < 0.08) was 96.2% and 72.4% for non-impacted third molars and 46.2% and 87% for impacted third molars, respectively. Our findings indicate that the cut-off value of I3M < 0.08 resulted in greater number of age misclassifications (false negatives) for impacted molars, highlighting the need for new cut-off value of I3M to meet the legal standards. It was concluded that the mineralization of impacted third molars was slower compared to non-impacted ones in south Indian males and females. Further studies are warranted to validate these findings among a larger and more diverse sample.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  1. Ritz-Timme S, Cattaneo C, Collins MJ, Waite ER, Schütz HW, Kaatsch HJ et al (2000) Age estimation: the state of the art in relation to the specific demands of forensic practise. Int J Legal Med 113(3):129–136

    CAS  Article  Google Scholar 

  2. Qing M, Qiu L, Gao Z, Bhandari K (2014) The chronological age estimation of third molar mineralization of Han population in southwestern China. J Forensic Legal Med 24:24–27

    Article  Google Scholar 

  3. Liversidge H, Berthold H, Friedrich W (1998) Dental age estimation of non-adults. A review of methods and principles. In: Alt KW, Rosing FW, Tescheler-Nicola M, editors. Dental anthropology, fundamentals, limits, and prospects. Vienna: Springer; 419–42

  4. 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(1):35–42

    CAS  Article  Google Scholar 

  5. Ubelaker DH, Khosrowshahi H (2019) Estimation of age in forensic anthropology: historical perspective and recent methodological advances. Forensic Sci Res 4(1):1–9

    Article  Google Scholar 

  6. Thevissen PW, Fieuws S, Willems G (2010) Human third molars development: comparison of 9 country specific populations. Forensic Sci Int 201(1–3):102–105

    CAS  Article  Google Scholar 

  7. Cameriere R, Flores-Mir C, Mauricio F, Ferrante L (2007) Effects of nutrition on timing of mineralization in teeth in a Peruvian sample by the Cameriere and Demirjian methods. Ann Hum Biol 34(5):547–556

    Article  Google Scholar 

  8. Timme M, Karch A, Shay D, Ottow C, Schmeling A (2020) The relevance of body mass index in forensic age assessment of living individuals: an age-adjusted linear regression analysis using multivariable fractional polynomials. Int J Legal Med 134(5):1861–1868

    Article  Google Scholar 

  9. Alfadil L, Almajed E (2020) Prevalence of impacted third molars and the reason for extraction in Saudi Arabia. The Saudi Dental Journal 32(5):262–268

    Article  Google Scholar 

  10. Topkara A, Sari Z (2013) Investigation of third molar impaction in Turkish orthodontic patients: prevalence, depth and angular positions. Eur J Dent 7(1):94–98

    Google Scholar 

  11. Kumar VR, Yadav P, Kahsu E, Girkar F, Chakraborty R (2017) Prevalence and pattern of mandibular third molar impaction in Eritrean population: a retrospective study. J Contemp Dent Pract 18(2):100–106

    Article  Google Scholar 

  12. Balla SB, Lingam S, Kotra A, P HR, P K, N NM et al (2019) New regression models for dental age estimation in children using third molar maturity index: a preliminary analysis testing its usefulness as reliable age marker. Legal Med 39:35–40

    Article  Google Scholar 

  13. Pilloud MA, Heim K (2019) A test of age estimation methods on impacted third molars in males. J Forensic Sci 64(1):196–200

    Article  Google Scholar 

  14. Ventä I, Turtola L, Ylipaavalniemi P (2001) Radiographic follow-up of impacted third molars from age 20 to 32 years. Int J Oral Maxillofac Surg 30(1):54–57

    Article  Google Scholar 

  15. 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

    CAS  Article  Google Scholar 

  16. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics. 33(1):159–174

    CAS  Article  Google Scholar 

  17. 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

    CAS  Article  Google Scholar 

  18. Hashemipour MA, Tahmasbi-Arashlow M, Fahimi-Hanzaei F (2013) Incidence of impacted mandibular and maxillary third molars: a radiographic study in a Southeast Iran population. Medicina Oral, Patologia Oral y cirugia bucal. 18(1):140–145

    Article  Google Scholar 

  19. Secic S, Prohic S, Komsic S, Vukovic A (2013) Incidence of impacted mandibular third molars in population of Bosnia and Herzegovina: a retrospective radiographic study. J Health Sci 3(2):151–158

    Google Scholar 

  20. Carter K, Worthington S (2016) Predictors of third molar impaction: a systematic review and meta-analysis. J Dent Res 95(3):267–276

    CAS  Article  Google Scholar 

  21. Marrero-Ramos MD, López-Urquía L, Suárez-Soto A, Sánchez-Villegas A, Vicente-Barrero M (2020) Estimation of the age of majority through radiographic evaluation of the third molar maturation degree. Med Oral Patol Oral Cir Bucal 25(3):359–363

    Article  Google Scholar 

  22. Quispe Lizarbe RJ, Solis Adrianzen C, Quezada-Marquez MM, Galic 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

    Article  Google Scholar 

  23. 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(6):869–874

    Article  Google Scholar 

  24. Svendsen H, Björk A (1988) Third molar impaction--a consequence of late M3 mineralization and early physical maturity. Eur J Orthod 10(1):1–12

    CAS  Article  Google Scholar 

  25. Lauesen SR, Andreasen JO, Gerds TA, Christensen SS, Borum M, Hillerup S (2013) Association between third mandibular molar impaction and degree of root development in adolescents. The Angle orthodontist 83(1):3–9

    Article  Google Scholar 

  26. Guo YC, Yan CX, Lin XW, Zhang WT, Zhou H, Pan F et al (2014) The influence of impaction to the third molar mineralization in northwestern Chinese population. Int J Legal Med 128(4):659–665

    Article  Google Scholar 

  27. Pinchi V, Pradella F, Vitale G, Rugo D, Nieri M, Norelli G-A (2016) Comparison of the diagnostic accuracy, sensitivity and specificity of four odontological methods for age evaluation in Italian children at the age threshold of 14 years using ROC curves. Med Sci Law 56(1):13–18

    Article  Google Scholar 

  28. 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-e6

  29. Balla SB, Galic I, P K, Vanin S, De Luca S, Cameriere R (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

    Article  Google Scholar 

  30. Kelmendi J, Cameriere R, Koçani F, Galić I, Mehmeti B, Vodanović M (2018) The third molar maturity index in indicating the legal adult age in Kosovar population. Int J Legal Med 132(4):1151–1159

    Article  Google Scholar 

  31. Gómez Jiménez L, Velandia Palacio LA, De Luca S, Ramirez Vasquez Y, Corominas Capellán M, Cameriere R (2019) Validation of the third molar maturity index (I3M): study of a Dominican Republic sample. J Forensic Odontostomatol 3(37):27–33

    PubMed  Google Scholar 

  32. Ribier L, Saint-Martin P, Seignier M, Paré A, Brunereau L, Rérolle C (2020) Cameriere's third molar maturity index in assessing age of majority: a study of a French sample. Int J Legal Med 134(2):783–792

    Article  Google Scholar 

  33. Kohler S, Schmelzle R, Loitz C, Puschel K (2004) Die Entwicklung des Weisheitszahnes als Kriterium der Lebensaltersbestimmung. Anat Anz 176:339–345

    Article  Google Scholar 

  34. Banar N, Bertels J, Laurent F, Boedi RM, De Tobel J, Thevissen P et al (2020) Towards fully automated third molar development staging in panoramic radiographs. Int J Legal Med 134(5):1831–1841

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sudheer Babu Balla.

Ethics declarations

Ethics approval

Obtained.

Informed consent

Obtained.

Conflict of interest

The authors declare no competing interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Balla, S.B., Kollata, V.R.S., Bathala, V. et al. Evaluation of the effect of impaction on the mineralization of mandibular third molars and forensic age estimation in a sample of south Indian children. Int J Legal Med 136, 861–869 (2022). https://doi.org/10.1007/s00414-021-02713-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00414-021-02713-w

Keywords

  • Age estimation
  • Forensic odontology
  • Mandibular third molars
  • Impaction
  • Age misclassifications
  • South Indians