Abstract
Third molars are one of the few biological markers available for age estimation in juveniles, especially for the estimation of the 18-year-age threshold. Literature has indicated that impaction has an influence on the development of third molars, which could possibly result in age misclassifications. The present study is intended to identify an alternative cut-off value of the third molar maturity index (I3M) in impacted mandibular third molars and also to evaluate its applicability in estimating the major (≥ 18 years)/minor (< 18 years) status. A total of 1330 digital orthopantomograms (OPGs) of 665 male and 665 female south Indian adolescents aged from 15 to 22 years were collected and assessed. Eight hundred forty OPGs (63.1%) represented test sample, and 490 OPGs (36.9%) represented validation sample. I3M was measured for the total sample. Logistic regression, receiver operating characteristic (ROC) curve analysis, and Youden’s index were used to test the performance of the method in the test sample. An alternative cut-off value of I3M < 0.17 was established for the highest value of the Youden’s index of 0.598 for both sexes. When tested in validation sample, it has resulted in sensitivity and specificity values of 0.91 (95% CI; 0.86–0.95) and 0.90 (95% CI; 0.78–0.91) in males and 0.86 (95% CI; 0.80–0.92) and 0.90 (95% CI; 0.83–0.95) in females. In conclusion, cut-off value of I3M < 0.17 could accurately discriminate adults from minors with impacted mandibular third molars. However, more work is needed to be done among a more diverse sample to confirm these findings.
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References
Liversidge HM, Herdeg B, Rösing FW (1998) Dental age estimation of non-adults. A review of methods and principles. In: Alt KW, Rösing FW, Teschler-Nicola M, editors. Dental Anthropology: Fundamentals, Limits and Prospects. Vienna: Springer Vienna 419–42
Mesotten K, Gunst K, Carbonez A, Willems G (2002) Dental age estimation and third molars: a preliminary study. Forensic Sci Int 129(2):110–115
Nambiar P (1995) Age estimation using third molar development. Malaysian J Pathol 17(1):31–34
Cardoso HFV, Caldas IM, Andrade M (2018) Dental and skeletal maturation as simultaneous and separate predictors of chronological age in post-pubertal individuals: a preliminary study in assessing the probability of having attained 16 years of age in the living. Aust J Forensic Sci 50(4):371–384
Demisch A, Wartmann P (1956) Calcification of the mandibular third molar and its relation to skeletal and chronological age in children. Child Dev 27(4):459–473
Krailassiri S, Anuwongnukroh N, Dechkunakorn S (2002) Relationships between dental calcification stages and skeletal maturity indicators in Thai individuals. Angle Orthod 72(2):155–166
Garamendi PM, Landa MI, Ballesteros J, Solano MA (2005) Reliability of the methods applied to assess age minority in living subjects around 18 years old. A survey on a Moroccan origin population. Forensic Sci Int 154(1):3–12
Pelsmaekers B, Loos R, Carels C, Derom C, Vlietinck R (1997) The genetic contribution to dental maturation. J Dent Res 76(7):1337–1340
Schmeling A, Schulz R, Danner B, Rösing FW (2006) The impact of economic progress and modernization in medicine on the ossification of hand and wrist. Int J Legal Med 120(2):121–126
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
Schmeling A, Geserick G, Reisinger W, Olze A (2007) Age estimation. Forensic Sci Int 165(2–3):178–181
Schmeling A, Garamendi PA, Prieto JL, Landa MI. Forensic age estimation in unaccompanied minors and young living adults, forensic medicine - from old problems to new challenges. Duarte Nuno Vieira, Intech Open. 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. Accessed 8 Oct 2021
Alfadil L, Almajed E (2020) Prevalence of impacted third molars and the reason for extraction in Saudi Arabia. Saudi Dent J 32(5):262–268
Passi D, Singh G, Dutta S, Srivastava D, Chandra L, Mishra S et al (2019) Study of pattern and prevalence of mandibular impacted third molar among Delhi-National Capital Region population with newer proposed classification of mandibular impacted third molar: a retrospective study. Natl J Maxillofac Surg 10(1):59–67
Carter K, Worthington S (2016) Predictors of third molar impaction: a systematic review and meta-analysis. J Dent Res 95(3):267–276
Eshghpour M, Nezadi A, Moradi A, Shamsabadi RM, Rezaei NM, Nejat A (2014) Pattern of mandibular third molar impaction: a cross-sectional study in northeast of Iran. Niger J Clin Pract 17(6):673–677
Kumar Pillai A, Thomas S, Paul G, Singh SK, Moghe S (2014) Incidence of impacted third molars: a radiographic study in People’s Hospital, Bhopal, India. J Oral Biol Craniofac Res 4(2):76–81
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
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
Pilloud MA, Heim K (2019) A test of age estimation methods on impacted third molars in males. J Forensic Sci 64(1):196–200
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):379–90
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):e359–e363
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
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. Leg Med 25:59–65
Balla SB, Kollata VRS, Bathala V, Ganapathy SK, Gayathri Ch, Vedula P, 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 (Under review)
Saker M, Ogle OE, Dym H (2009) Basic and complex exodontia and surgical management of impacted teeth. In: Fonseca RJ, Marciania RD, Turvey TA (eds) Oral and maxillofacial surgery. Saunders-Elsevier, Philadelphia, pp 185–211
Schisterman EF, Perkins NJ, Liu A, Bondell H (2005) Optimal cut-point and its corresponding Youden Index to discriminate individuals using pooled blood samples. Epidemiology 16(1):73–81
Deeks JJ, Altman DG (2004) Diagnostic tests 4: likelihood ratios. BMJ (Clinical research ed) 329(7458):168–169
Office of the Registrar General & Census Commissioner, India. Available from: https://www.censusindia.gov.in/2011census/C-series/C-13.html (Last accessed 26th February 2021)
Balla SB, Galic I, Karunakar P, 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 Leg Med 49:2–7
Khare P, Li J, Velandia Palacio LA, Galić I, Ferrante L, Cameriere R (2020) Validation of the third molar maturity index cut-off value of <0.08 for indicating legal age of 18 years in Eastern Chinese region. Leg Med 42:101645
Antunovic M, Galic I, Zelic K, Nedeljkovic N, Lazic E, Djuric M et al (2018) The third molars for indicating legal adult age in Montenegro. Leg Med 33:55–61
Angelakopoulos N, De Luca S, Velandia Palacio LA, Coccia E, Ferrante L, Cameriere R (2018) Third molar maturity index (I(3M)) for assessing age of majority: study of a black South African sample. Int J Legal Med 132(5):1457–1464
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
Różyło-Kalinowska I, Kalinowski P, Kozek M, Galić I, Cameriere R (2018) Validity of the third molar maturity index I3M for indicating the adult age in the Polish population. Forensic Sci Int 290:352.e1-e6
AlQahtani S, Kawthar A, AlAraik A, AlShalan A (2017) Third molar cut-off value in assessing the legal age of 18 in Saudi population. Forensic Sci Int 272:64–67
Akkaya N, Yilanci HÖ (2020) Assessment of third molar maturity index for legal age threshold of 18 in a sample of Turkish individuals. Aust J Forensic Sci 53(3):314–324
Gulsahi A, De Luca S, Cehreli SB, Tirali RE, Cameriere R (2016) Accuracy of the third molar index for assessing the legal majority of 18 years in Turkish population. Forensic Sci Int 266(584):e1-6
Boyacıoğlu Doğru H, Gulsahi A, Çehreli SB, Galić I, van der Stelt P, Cameriere R (2018) Age of majority assessment in Dutch individuals based on Cameriere’s third molar maturity index. Forensic Sci Int 282:231.e1-e6
Kumagai A, Takahashi N, Palacio LAV, Giampieri A, Ferrante L, Cameriere R (2019) Accuracy of the third molar index cut-off value for estimating 18 years of age: validation in a Japanese samples. Leg Med 38:5–9
Sharma P, Wadhwan V, Ravi Prakash SM, Aggarwal P, Sharma N (2017) Assessment of age of majority by measurement of open apices of the third molars using Cameriere’s third molar maturity index. J Forensic Dent Sci 9(2):96–101
Nóbrega JBMd, Protasio APL, Ribeiro ILA, Valença AMG, Santiago BM, Cameriere R (2019) Validation of the third molar maturation index to estimate the age of criminal responsibility in Northeastern Brazil. Forensic Sci Int 304:109917
Cavrić J, Galić I, Vodanović M, Brkić H, Gregov J, Viva S et al (2016) Third molar maturity index (I3M) for assessing age of majority in a black African population in Botswana. Int J Legal Med 130(4):1109–1120
Schmeling A, Grundmann C, Fuhrmann A, Kaatsch HJ, Knell B, Ramsthaler F et al (2008) Criteria for age estimation in living individuals. Int J Legal Med 122(6):457–460
Chu G, Wang YH, Li MJ, Han MQ, Zhang ZY, Chen T et al (2018) Third molar maturity index (I(3M)) for assessing age of majority in northern Chinese population. Int J Legal Med 132(6):1759–1768
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
Schmeling A, Dettmeyer R, Rudolf E, Vieth V, Geserick G (2016) Forensic age estimation: methods, certainty, and the law. Dtsch Arztebl Int 113(4):44–50
Haavikko K, Altonen M, Mattila K (1978) Predicting angulational development and eruption of the lower third molar. Angle Orthod 48(1):39–48
Yilmaz S, Adisen MZ, Misirlioglu M, Yorubulut S (2016) Assessment of third molar impaction pattern and associated clinical symptoms in a Central Anatolian Turkish population. Med Princ Pract 25(2):169–175
Saputri RI, De Tobel J, Vranckx M, Ockerman A, Van Vlierberghe M, Fieuws S et al (2021) Is third molar development affected by 594 third molar impaction or impaction-related parameters? Clin Oral Invest. https://doi.org/10.1007/s00784-021-03955-z
Sandhu S, Kaur T (2005) Radiographic evaluation of the status of third molars in the Asian-Indian students. J Oral Maxillofac Surg 63(5):640–645
Björk A, Jensen E, Palling M (1956) Mandibular growth and third molar impaction. Acta Odontol Scand 14:231–272
Kunjur J, Sabesan T, Ilankovan V (2006) Anthropometric analysis of eyebrows and eyelids: an inter-racial study. Br J Oral Maxillofac Surg 44(2):89–93
Keng SB, Foong KW (1996) Maxillary arch and central incisor dimensions of an ethnic Chinese population in relation to complete denture prosthodontics. Int Dent J 46(2):103–107
Ishwarkumar S, Pillay P, Haffajee M, Satyapal K (2019) Prevalence of impacted third molars in the South African Indian population of the eThekwini Metropolitan Region. S Afr Dent J 74:302–309
Khan A, Khitab U, Khan MT (2010) Impacted mandibular third molars: pattern of presentation and postoperative complication. Pak Oral Dent J 30(2):307–312
Pinchi V, Pradella F, Vitale G, Rugo D, Nieri M, Norelli GA (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
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Balla, S.B., Nambi, N.K., Nambi, S. et al. Legal age determined by a new threshold value of third molar maturity index in subjects with impacted mandibular third molars: An orthopantomographic study in south Indian adolescents. Int J Legal Med 136, 251–259 (2022). https://doi.org/10.1007/s00414-021-02715-8
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DOI: https://doi.org/10.1007/s00414-021-02715-8