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Diagnostic accuracy of the third molar maturity index (I3M) to assess the age of legal majority in Northern Brazil—population-specific cut-off values

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Abstract

International guidelines for dental age assessment have recommended the use of methods based on available population-specific data. The Third Molar Maturity Index (I3M) was previously validated in several populations worldwide. This was the first study to evaluate the I3M in a northern Brazilian population and to test the diagnostic accuracy of the method to distinguish between minors and adults. The sample consisted of 1.070 panoramic radiographs retrospectively collected from females (n = 595) and males (n = 475) with ages between 16 and 22 years. I3M’s original cut-off value of 0.08 was used to classify individuals below and above the age of 18. Receiver operating characteristic (ROC) curves were plotted to assess the accuracy (ACC) of the method. In females and males separately, the overall ACC was 73.1% and 80%, respectively. The overall ACC for the combined sample was 76.1%. For northern Brazilian males, the best cut-off value remained 0.08, while for females, an adjustment to 0.12 showed optimal outcomes. The new cut-off value led to an ACC of 98.5% for females, which reflected an increase of 25.5% compared to the original cut-off value. The original cut-off value proposed by I3M was applicable to the present sample of northern Brazilian individuals. Adjustments to 0.12, however, may be encouraged to enhance the performance of the method among females.

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References

  1. American Board of Forensic Odontology (2020) Dental age assessment procedures. Available at: http://abfo.org/wp-content/uploads/2016/06/Dental-Age-Assessment-Procedures-Chart-2016.pdf. Accessed 19 April 2022

  2. Schmeling A, Grundmann C, Fuhrmann A, Kaatsch HJ, Knell B, Ramsthaler F, Reisinger W, Riepert T, Ritz-Timme S, Rösing FS, Rötzscher K, Geserick G (2008) Criteria for age estimation in living individuals. Int J Legal Med 122:457–460. https://doi.org/10.1007/s00414-008-0254-2

    Article  CAS  PubMed  Google Scholar 

  3. American Board of Forensic Odontology (2020) ABFO standards and guidelines for dental age assessment. Available at: http://abfo.org/wp-content/uploads/2021/02/ADA-Technical-Report-No.-1077_July_2020.-02-2021.pdf. Accessed 19 April 2022

  4. Thevissen PW, Fieuws S, Willems G (2010) Human third molars development: comparison of 9 country specific populations. Forensic Sci Int 201:102–105. https://doi.org/10.1016/j.forsciint.2010.04.054

    Article  CAS  PubMed  Google Scholar 

  5. Lewis JM (2010) Senn DR (2010) Dental age estimation utilizing third molar development: a review of principles, methods, and population studies used in the United States. Forensic Sci Int 201:79–83. https://doi.org/10.1016/j.forsciint.2010.04.042

    Article  PubMed  Google Scholar 

  6. Thevissen P, Altalie S, Brkić H, Galić I, Fieuws S, Franco A, Lee SS, Pinchi V, Yusof MYPM, Willems G (2013) Comparing 14 country-specific populations on third molars development: consequences for age predictions of individuals with different geographic and biological origin. J F Odontostomatol 31:87–88

    Google Scholar 

  7. 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 38:379–390

    Article  CAS  Google Scholar 

  8. International Organization of Forensic Odonto-Stomatology (2018) Recommendations for quality assurance: dental age estimation. Available at: http://www.iofos.eu/Quality-Ass/QA_2018_final/Age_estimation_final.pdf. Accessed 19 April 2022

  9. 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 122:493–497. https://doi.org/10.1007/s00414-008-0279-6

    Article  CAS  PubMed  Google Scholar 

  10. Franco RPAV, Franco A, Turkina A, Arakelyan M, Arzukanyan A, Velenko P, Bortolami PB, Makeeva I, da Silva RHA (2021) Radiographic assessment of third molar development in a Russian population to determine the age of majority. Arch Oral Biol 125:105102. https://doi.org/10.1016/j.archoralbio.2021.105102

    Article  PubMed  Google Scholar 

  11. 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. https://doi.org/10.1016/j.forsciint.2017.01.004

    Article  PubMed  Google Scholar 

  12. 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.e1-584. https://doi.org/10.1016/j.forsciint.2016.04.034

    Article  Google Scholar 

  13. Zelic K, Galic I, Nedeljkovic N, Jakovljevic A, Milosevic O, Djuric M, Cameriere R (2016) Accuracy of Cameriere’s third molar maturity index in assessing legal adulthood on Serbian population. Forensic Sci Int 259:127–132. https://doi.org/10.1016/j.forsciint.2015.12.032

    Article  PubMed  Google Scholar 

  14. 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 134:783–792. https://doi.org/10.1007/s00414-019-02123-z

    Article  PubMed  Google Scholar 

  15. De Luca S, Biagi R, Begnoni G, Farronato G, Cingolani M, Merelli V, Ferrante L, Cameriere R (2014) Accuracy of Cameriere’s cut-off value for third molar in assessing 18 years of age. Forensic Sci Int 235:102.e1–6. https://doi.org/10.1016/j.forsciint.2013.10.036

    Article  Google Scholar 

  16. Goetten IFS, Silva RF, Franco A (2021) Skeletal and dental age estimation of the living in a criminal scenario – case report. Rom J Legal Med 29:105–108. https://doi.org/10.4323/rjlm.2021.105

    Article  Google Scholar 

  17. Silva RF, Mendes SDSC, Franco A, Dias PEM, Martorell LB (2013) Documental vs biological evidence for age estimation forensic case report ROBRAC 21:6–10. https://doi.org/10.36065/robrac.v22i60.731

    Article  Google Scholar 

  18. Franco A, Vetter F, Coimbra EF, Fernandes Â, Thevissen P (2020) Comparing third molar root development staging in panoramic radiography, extracted teeth, and cone beam computed tomography. Int J Legal Med 134:347–353. https://doi.org/10.1007/s00414-019-02206-x

    Article  PubMed  Google Scholar 

  19. Sartori V, Franco A, Linden MS, Cardoso M, de Castro D, Sartori A, Silva C, Trentin M, De Carli JP (2021) Testing international techniques for the radiographic assessment of third molar maturation. J Clin Exp Dent 13:e1182–e1188. https://doi.org/10.4317/jced.58916

    Article  PubMed  PubMed Central  Google Scholar 

  20. Gaêta-Araujo H, Oliveira-Santos N, Nascimento EHL, Nogueira-Reis F, Oenning AC, Groppo FC, Oliveira-Santos C (2021) A new model of classification of third molars development and its correlation with chronological age in a Brazilian subpopulation. Int J Legal Med 135:639–648. https://doi.org/10.1007/s00414-020-02401-1

    Article  PubMed  Google Scholar 

  21. Santiago BM, Almeida L, Cavalcanti YW, Magno MB, Maia LC (2018) Accuracy of the third molar maturity index in assessing the legal age of 18 years: a systematic review and meta-analysis. Int J Legal Med 132:1167–1184. https://doi.org/10.1007/s00414-017-1766-4

    Article  PubMed  Google Scholar 

  22. Deitos AR, Costa C, Michel-Crosato E, Galić I, Cameriere R, Biazevic MGB (2015) Age estimation among Brazilians: younger or older than 18? J Forensic Legal Med 33:111–115. https://doi.org/10.1016/j.jflm.2015.04.016

    Article  Google Scholar 

  23. Mazzilli LEN, Melani RFH, Lascala CA, Palacio LAV, Cameriere R (2018) Age estimation: Cameriere’s open apices methodology accuracy on a southeast Brazilian sample. J Forensic Leg Med 58:164–168. https://doi.org/10.1016/j.jflm.2018.06.006

    Article  PubMed  Google Scholar 

  24. Correia AM, Barbosa DS, Alcantara JAS, Oliveira PMC, Silva PGB, Franco A, Bezerra TP (2020) Performance and comparison of the London Atlas technique and Cameriere’s third molar maturity index (I3M) for allocating individuals below or above the threshold of 18 years. Forensic Sci Int 317:110512. https://doi.org/10.1016/j.forsciint.2020.110512

    Article  PubMed  Google Scholar 

  25. Nóbrega JBM, 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. https://doi.org/10.1016/j.forsciint.2019.109917

    Article  PubMed  Google Scholar 

  26. Franco A, Vidigal MTC, Oliveira MV, Nascimento CTJS, Silva RF, Paranhos LR (2020) Evidence-based mapping of third molar techniques for age estimation applied to Brazilian adolescents a systematic review. Res Soc Develop 9:e9339109395. https://doi.org/10.33448/rsd-v9i10.9395. Accessed 19 April 2022

    Article  Google Scholar 

  27. BRASIL (2012) National Council of Health. Resolution n. 466 of December 12th. Available at: https://bvsms.saude.gov.br/bvs/saudelegis/cns/2013/res0466_12_12_2012.html. Accessed 19 April 2022

  28. WMA – World Medical Association (2013) Declaration of Helsinki. Available at: https://www.wma.net/what-we-do/medical-ethics/declaration-of-helsinki/. Accessed 19 April 2022

  29. Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, Initiative STROBE (2008) The Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61:344–349. https://doi.org/10.1016/j.jclinepi.2007.11.008

    Article  Google Scholar 

  30. Moukarzel M Angelakopoulos N, De Luca S, Palacio LAV, Aquilanti L, Coccia E, Pigolkin YI, Cameriere R (2020) Validity assessment of the third molar maturity index (I3M) in a Lebanese sample of adolescents and young adults Aust J Forensic Sci Epub:1–12 https://doi.org/10.1080/00450618.2020.1805008

  31. De Micco F, Martino F, Velandia Palacio LA, Cingolani M, Campobasso CP (2021) Third molar maturity index and legal age in different ethnic populations: accuracy of Cameriere’s method. Med Sci Law 6:105–112. https://doi.org/10.1177/0025802419900686

    Article  Google Scholar 

  32. Vasconcelos KF, Nicolielo LFP, Nascimento MC, Haiter-Neto F, Bóscolo FN, Van Dessel J, EzEldeen M, Lambrichts I, Jacobs R (2015) Artefact expression associated with several cone-beam computed tomographic machines when imaging root filled teeth. Int Endod J 48:994–1000. https://doi.org/10.1111/iej.12395

    Article  CAS  PubMed  Google Scholar 

  33. Nascimento EHL, Gaêta-Araujo H, Vasconcelos KF, Freire BB, Oliveira-Santos C, Haiter-Neto F, Freitas DQ (2018) Influence of brightness and contrast adjustments on the diagnosis of proximal caries lesions. Dentomaxillofac Radiol 47:20180100. https://doi.org/10.1259/dmfr.20180100

    Article  PubMed  PubMed Central  Google Scholar 

  34. Neves JA, Antunes-Ferreira N, Machado V, Botelho J, Proença L, Quintas A, Delgado AS, Mendes JJ, Cameriere R (2020) Validation of the Third Molar Maturation Index (I3M) to assess the legal adult age in the Portuguese population. Sci Rep 10:18466. https://doi.org/10.1038/s41598-020-75324-x

    Article  CAS  Google Scholar 

  35. Koo TK, Li MY (2016) A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 15:155–163. https://doi.org/10.1016/j.jcm.2016.02.012

    Article  PubMed  PubMed Central  Google Scholar 

  36. Angelakopoulos N, Galić I, Balla SB, Kiş HC, Gómez Jiménez L, Zolotenkova G (2021) Comparison of the third molar maturity index (I 3M) between left and right lower third molars to assess the age of majority: a multi-ethnic study sample. Int J Legal Med 135:2423–2436. https://doi.org/10.1007/s00414-021-02656-2

    Article  CAS  PubMed  Google Scholar 

  37. Tafrount C, Galic I, Franchi A, Fanton L, Cameriere R (2019) Third molar maturity index for indicating the legal adult age in Southeastern France. Forensic Sci Int 294:218.e1-218.e6. https://doi.org/10.1016/j.forsciint.2018.10.013

    Article  Google Scholar 

  38. 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 Legal Med 49:2–7. https://doi.org/10.1016/j.jflm.2017.05.003

    Article  Google Scholar 

  39. Cameriere R, Santoro V, Roca R, Lozito P, Introna F, Cingolani M, Galic I, Ferrante L (2014) Assessment of legal adult age of 18 by measurement of open apices of the third molars: study on the Albanian sample. Forensic Sci Int 245:205.e1–5. https://doi.org/10.1016/j.forsciint.2014.10.013

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Forensic Dentistry, Faculdade Sao Leopoldo Mandic, Campinas, Brazil

    Izabella Ferreira dos Santos Goetten & Ademir Franco

  2. Division of Oral Radiology, Faculdade Sao Leopoldo Mandic, Campinas, Brazil

    Anne Caroline Costa Oenning

  3. Department of Forensic Dentistry, Federal University of Goias, Goiânia, Brazil

    Rhonan Ferreira Silva

  4. Section of Legal Medicine, Laboratory of Human Identification, University of Turin, Turin, Italy

    Emilio Nuzzolese

  5. Medical and Odontological Imaging Clinic (CIMO), Manaus, Brazil

    Ernesto Lourenço Junior

  6. Department of Therapeutic Stomatology, Institute of Dentistry, Sechenov University, Moscow, Russia

    Ademir Franco

  7. Centre of Forensic and Legal Medicine and Dentistry, University of Dundee, Nethergate DD1 4HN, Level 7, Dundee, T7015, UK

    Ademir Franco

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  1. Izabella Ferreira dos Santos Goetten
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  2. Anne Caroline Costa Oenning
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  5. Ernesto Lourenço Junior
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  6. Ademir Franco
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Corresponding author

Correspondence to Ademir Franco.

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Ethics approval

Protocol number 44953421.2.0000.5374.

Research involving human participants and/or animals

The research involved human participants. The study was observational, and the sample was collected retrospectively from an existing image database. The Declaration of Helsinki (2013) was followed, and ethical approval was obtained from the institutional committee of ethics in human research.

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N/A (the study had a retrospective sample collection of an image database).

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The authors declare no competing interests.

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Goetten, I.F.d., Oenning, A.C.C., Silva, R.F. et al. Diagnostic accuracy of the third molar maturity index (I3M) to assess the age of legal majority in Northern Brazil—population-specific cut-off values. Int J Legal Med 136, 1507–1514 (2022). https://doi.org/10.1007/s00414-022-02857-3

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