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Comparison of three methods to estimate dental age in children

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In 1973, Demirjian and colleagues introduced a staging for tooth mineralization. Staging of the teeth of the left mandible generates a dental maturity score and an estimate of dental age. An update of this method was published in 2001 by Willems and colleagues. The London Atlas (2008) is another method used to assess dental age. This study compared the precision of these three methods for forensic age estimation.

Materials and methods

A total of 500 panoramic images of 251 boys and 249 girls aged 6–16 years had dental maturity evaluated by the same observer using the London Atlas and the methods of Demirjian and Willems. Individuals with syndromes potentially affecting dental maturation were excluded. The three methods were compared with respect to their precision in estimating chronological age.


Age estimates using Willems’ method were significantly more precise than those obtained using Demirjian’s method, while estimates obtained using the London Atlas method were comparable with both the others. The highest precision was obtained using the average of age estimates from Willems’ method and the London Atlas.


To estimate age in individuals suspected of being below 16 years of age, we suggest first applying the London Atlas then computing age from the Demirjian stages of particular teeth using Willems’ method, and finally using the average age estimate of both methods.

Clinical relevance

Combining the London Atlas and Willems’ scoring method provides more precise estimates of dental age than the current practice of applying a single preferred method.

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The authors wish to thank Professor Angelika Stellzig-Eisenhauer, director of the Department of Orthodontics of the University Hospital Würzburg, for granting access to the radiographic archive data of her policlinic and providing the opportunity to extract anonymous image material for scientific research. The authors also wish to express their gratitude to the anonymous reviewers whose comments were very helpful in improving the presentation of this work.

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Authors and Affiliations



BG had the idea and developed the plan for the study. CC collected the data under the guidance and supervision of GG, and BG checked data for plausibility. GG performed the statistical analyses. BG and GG interpreted the results and prepared the first draft of the manuscript. CC critically revised the manuscript. All authors approved the submission and take responsibility for the integrity of the data and analyses.

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Correspondence to Bianca Gelbrich.

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The authors declare that they have no conflict of interest.

Ethical approval

This study retrospectively evaluated anonymous radiographic images obtained in routine clinical practice. Therefore, no ethical evaluation or approval was required according to applicable German law. This was confirmed by the Ethics Committee of the Medical Faculty of the University of Würzburg (reference number 20170317-01).

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It was determined that no formal consent was required for this study.

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Gelbrich, B., Carl, C. & Gelbrich, G. Comparison of three methods to estimate dental age in children. Clin Oral Invest 24, 2469–2475 (2020).

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