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Dental age assessment by the pulp/tooth area proportion in cone beam computed tomography: is medico-legal application for age estimation reliable
Adriana Costa Pires, Rui Filipe Vargas de Sousa Santos, Cristiana Palmela Pereira
Introduction: Forensic dentistry has, as one of its main goals, the identification of living and/or deceased individuals, based on the individual features of the teeth. One of the identification criteria to be established is the chronological age. Several authors, including Kvaal, have developed age estimation methods based on secondary dentine deposition. Nowadays, three-dimensional imaging tests, such as Cone Beam Computed Tomography (CBCT), are used in age estimation.
Objective: The aims of this research project were to validate Kvaal’s method and its variables in age estimation and to create new linear regression formulae to better represent the study sample.
Methods: We selected 158 CBCT, with a total of 402 sound teeth (central incisors, lateral incisors and canines). The necessary measurements and ratios were calculated in both coronal and sagittal sections, with XelisDental®. The formulae developed by Kvaal for age estimation calculation were applied. Subsequently, the results were statistically analyzed.
Results and Discussion: The intraclass correlation coefficients from the two measurements ranged from 0.918 to 0.997. The calculated age estimation had a mean error of -21.4years (coronal section) and -26.3years (sagittal section). The t test revealed statistically significant differences between chronological age and estimated age. The absolute values of Pearson’s correlation coefficient between age and the two Kvaal variables ranged from 0.06 to 0.38 and from 0.06 to 0.55. The coefficients of determination are lower than in the original study (between 0.03 and 0.39). In the linear regression formulae, the coefficients of determination ranged from 0.07 to 0.41.
Conclusion: This investigation concludes a non-reproducibility of Kvaal’s method in the Portuguese population when applied in CBCT, with statistically significant differences between the chronological age and the dental age, estimated by the pulp/tooth proportion method, based on the teeth analyzed in this study.
(J Forensic Odontostomatol 2021, 39; 2-2:14)
Professional liability: assessment of court sentences for lawsuits against dentists in Peru
Silvana Requena Calla, Erika Alvarado Muñoz
Introduction: The number of reported dental malpractice cases has increased in recent years. The aim of this study was to analyze the characteristics of Peruvian court sentences related to dental procedures.
Materials and methods: In the present descriptive study, 33 sentences issued by the civil court of Peru, from 2011 to 2016 were collected. Useful information from the sentences was extracted and analyzed using the SPSS 18 software.
Results: Data showed that dentists were found guilty in 84.8% of sentences due to absence of suitability in dental treatment. Male dentists (61.1%) were involved in more cases than female dentists. Prosthodontics (33.3%) was the dental specialty subject to most claims.
Conclusions: Dentists like other health professionals are regulated by legal rules in the country they practise. As part of dental practice and in order to avoid claims, having a full clinical history and informed consent should be mandatory.
(J Forensic Odontostomatol 2021, 39; 2-15:20)
Can root pulp visibility in mandibular first molars be used as an alternative age marker at the 16 year threshold in the absence of mandibular third molars: an orthopantomographic study in a South Indian sample
Suvarna Manthapuri, Srikanth Bheemanapalli, Lakshmi Prasanna Namburu, Saranya Kunchala, Deepika Vankdoth, Sudheer B. Balla,Vanitha Bathala, Aishwarya Lakshmi Kasabu
In many countries, the 16 years of age threshold is considered to be legally relevant according to the law. This research aims to ascertain the sensitivity and specificity of Olze et al. stages of root pulp visibility (RPV) in a sample of 760 south Indian children aged between 12 and 20 years, with an age threshold of 16 years, using receiver operating characteristic curves and area under the curve (AUC). Spearman’s rho correlation showed a strong positive correlation between the RPV stages and age. No significant difference between the right and left lower first molars was seen. RPV Stage 2 showed the highest AUC in both females (0.813) and males (0.790). The performance of the RPV Stage 2 to discriminate the legal age threshold of 16 years resulted in the sensitivity, specificity and accuracy values of 0.61, 0.96 and 0.77 in males, 0.65, 0.97 and 0.80 in females. It resulted in 3.6% and 2.9% of false positives and 38.5% and 34.5% of false negatives in both sexes. Even though, RPV Stage 2 can discriminate reasonably well between two age categories, due to the high percentage of false negatives we recommend its use in conjunction with other age estimation methods.
(J Forensic Odontostomatol 2021, 39; 2-21:31)
Dental age assessment based on the radiographic visibility of the periodontal ligament in lower third molars in a Thai sample
Weeraya Tantanapornkul, Ruchadaporn Kaomongkolgit, Sirilawan Tohnak, Chutamas Deepho, Ronnayut Chansamat
The objective of the present study was to analyze the radiographic visibility of the periodontal ligament in completed root formation lower third molars in a sample of lower northern Thai population. Digital panoramic images from 800 patients with ages ranging from 16 to 26 years were used in this study. The visibility status of the periodontal ligament of lower third molars with completed root formation including apical closure was assessed. For each stage, the minimum age, maximum age, median, mean, and standard deviation were calculated. The minimum age found in stage 0 was 16.17 years in males and 17.00 years in females. Stage 1 was first achieved at the age of 16.17 years in males and 17.08 years in females. The earliest onset of stage 2 was 17.00 years in males and 18.17 years in females. The incidence of stage 3 was first observed at 19.17 years in males and 18.83 years in females. It may be concluded that the radiographic visibility of the periodontal ligament in lower third molars may be a useful approach in the dental age assessment in a Thai population. In case the periodontal ligament visibility is found to be in stage 2, it may be confirmed that the individual is at least 18 years of age.
(J Forensic Odontostomatol 2021, 39; 2-32:37)
Accuracy of Kvaal’s radiographic and translucent dentinal root techniques of extracted teeth in Malay adults for dental age estimation
Intan Syakirah Ramli, Ummi Solehah Muhd, Mohd Yusmiaidil Putera Mohd Yusof
The use of teeth to estimate the age of unknown bodies provides much help especially in skeletal remains with no soft tissues left for identification. However, dental age estimation utilizing degenerative changes in teeth like dentinal translucency is often hampered with large margin of error. This study aims to compare the accuracy of Kvaal’s radiographic method (intraoral periapical radiograph) with modified Bang-Ramm dentinal root translucency method in estimating dental age in Malay adults. One-hundred teeth of maxillary and mandibular incisors and canine were collected following dental extraction. Date of birth, date of extraction, gender and ethnicity were documented prior to extraction. All teeth were assessed using two methods of dental age estimation: 1) The equation from Kvaal’s radiographic method and 2) Formula from modified Bang-Ramm dentinal root translucency method. The results from the age estimation were compared to the chronological age of the persons from whom the teeth were extracted. The average dental age estimated using both methods significantly correlated with the chronological age for both men and women. Overestimation and underestimation with mean absolute error up to 13 years and 15 years was observed in modified Bang-Ramm and Kvaal, respectively. The estimated age calculated from both methods also showed increasing standard deviation as the patient gets older.From the obtained results it is reasonable to conclude that modified Bang-Ramm method gives better accuracy for dental age estimation in Malay adults.
(J Forensic Odontostomatol 2021, 39; 2-38:44)
Forensic dental identification in complicated fractured skull conditions: case report with adapted algorithm for image comparison
Volodymyr D. Mishalov, Myroslav Y. Goncharuk-Khomyn, Valeriy V. Voichenko, Hrvoje Brkic, Svitlana B. Kostenko, Valeriy V. Vyun, Pavlo P. Brekhlichuk
Objective: To analyze the perspective of using an adapted algorithm for digital images comparison while providing forensic dental identification in complicated fractured skull conditions by ante-mortem and post-mortem radiographical data sets.
Materials and Methods: Ante-mortem orthopantomogram and post-mortem peri-apical X-ray images were converted in *.jpeg format with their further import into GIMP 2.10 software (The GIMP Development Team). Segmentation of OPG-image was provided in topographical projections of jaw segments obtained directly from the victim. Comparison of analyzed image segments was provided manually within GIMP 2.10 software using functions of “Layers” and “Opacity” through the proposed algorithm.
Results: Considering the fact that 20 positive concordant dental identifiers overall were verified during comparison of AM and PM X-ray datasets, we can conclude that odontological identity was established. All above-mentioned discrepancies could be classified as explainable. Inter-agreement rate between two investigators considering correspondence between AM and PM datasets reached Cohen’s kappa level which is equal to 0,97, while positive 100% agreement was reached considering 21 out of 24 analyzed characteristics.
Conclusion: Available AM and PM radiographical datasets represent a sufficient information for effective forensic dental identification, even if such were obtained by different roentgenological techniques (orthopantomography and periapical radiography). Using of an adapted algorithm for digital images comparison with forensic dental purposes could potentially overcome cognitive bias and observer’s effect, speed up the process of analysis and increase the accuracy and inter-agreement rate while referencing AM and PM datasets.
(J Forensic Odontostomatol 2021, 39; 2-45:57)