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Current multifactorial age estimation methods are based on radiography, however, in the forensic field there is growing interest in using magnetic resonance imaging (MRI). With regard to the carpal region, MRI provides more information for defining the individual ossification nuclei and the cartilage surrounding single bones. During the phase of bone growth, the progressive reduction of the cartilage layer is accompanied by the development of a cartilage-bone interface. The aim of our study was to create a new model for age estimation, based on the ratio between the area occupied by the nucleus of ossification (NO) and the surface of growth (SG) of each carpal bone, the latter derived by adding NO to the area of cartilage-bone interface. We analyzed 57 MRI scans of Italian subjects aged between 12 and 20 years, without growth diseases, endocrine disorders or osteodystrophy. Measurements of NO and SG areas were extracted using ImageJ software, and the ratio between the NO and SG of each bone (NOSG) was calculated. A multiple linear regression model was used to estimate the individual's age as a function of the variables: gender and wrist bone measurements. The results showed that the best model was obtained with 6 predictors (nvmax=6): Gender, and the NOSG of the Trapezoid, Trapezium, Scaphoid, Pisiform, and Capitate. The median of the residuals (observed age minus predicted age) was -0.025 years, with an IQR of 0.19 years. Thus a new forensic approach to age assessment using MRI is introduced in this paper, which gives the preliminary results., (Copyright © 2020 Elsevier B.V. All rights reserved.)

The estimation of the age of majority is crucial to determine the legal accountability of an individual. With this purpose, the analysis of the dental development process has proven to be an effective, elucidatory method. This study investigated the applicability of the Third Molar Maturation Index (I 3M ), proposed by Cameriere et al. (2008), to estimate the age of majority in a sample of Northeastern Brazilians using panoramic radiographs. Adobe® Photoshop® CS4 (Adobe Systems Incorporated, San Jose, California, USA) software was used to obtain the I 3M index measurements in a sample of radiographs from a dental radiology clinic located in Northeastern Brazil. Radiographs of individuals aged between 14 and 23 years were included in the sample, except if showing absence, distortions, pathological alterations or suspected pulp impairment of the tooth #38 (third lower left molar), as the method applies exclusively to this element. Of the total sample of radiographs previously obtained for diagnostic and/or orthodontic purposes (n=394), 185 were from males and 209 from females, of which 217 corresponded to 18 year-olds or older and 177 were from minors. Logistic regression and predictive values of sensitivity, specificity and Receiver Operating Characteristic (ROC) curve (α=0.05) were used. The cutoff point originally proposed for the I 3M index (0.08) presented a sensitivity of 88.4% and a specificity of 73.2%, with accuracy (area under the ROC curve) of 80.8% (95%CI: 76.4-85.3%) for the Northeastern Brazilian population, as well as a correct age classification in 80.2% of the sample. The method estimated accurately 73.7% of the cases corresponding to "18 years or older" and 88.1% of the cases "under 18years" (p=0.000). Among the sexes, the correct age classification rate of the method was 84.3% for males and 76.6% for females, with no statistically significant difference between the match and error rates and between the sexes (p≥0.05). In conclusion, the Third Molar Maturation Index could accurately distinguish the age of adolescents and young adults of both sexes aged 18 years or under/older in a Brazilian population., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Tooth development evaluation is majorly the current approach to identify age and maturity. Dental age (DA) is therefore considerably emphasized in forensic and pediatric dentistry. The aim of this study was to assess the applicability of Willems and Cameriere methods for Turkish children. Panoramic images of 636 Turkish healthy children (319 male; 317 female) aged between 6 and 15 years were assessed. DA of the subjects was determined by using Willems and Cameriere methods. The seven right and left permanent lower teeth were valued using these two methods. The mean chronological age (CA) of the subjects was 11.53±2.25 (min:6, max:14.99) years (boys: 11.29±2.34 years, girls: 11.77±2.15 years). Willems method overestimated the CA (p≤0.001), in contrast, Cameriere method underestimated the CA (p≤0.001) for both sexes. In different age groups the mean difference between the CA and DA calculated by Cameriere method (CADA) ranged from 0.86 to -0.41 years for boys and from 1.00 to -0.21 years for girls, while the mean difference between the CA and DA calculated by Willems method ranged from -0.26 to -0.71 years for boys and from 0.19 to -0.76 years for girls. Cameriere method provided a better percentage of accuracy (84.6% and 77.3% for males and females, respectively) in the absolute difference values within 1 year compared to Willems method. Cameriere method performed slightly better but, both methods may be used for DA estimation in the Turkish population., (Copyright © 2019 Elsevier B.V. All rights reserved.)

The estimation of age in living subjects is today a significant issue because of the increase in the situations in which it arises and its legal consequences. In line with the Study Group on Forensic Age Diagnostics of the German Association of Legal Medicine's recommendations, it is based on the concomitant use of physical examination and methods for estimating bone age and dental age. Given the variations between the populations, the use of the latter requires their validation on all the ethnic groups on which they can be used. This aim of this study was to access the interest of the Cameriere's third molar maturity index (I 3M ) to indicate if an individual had reached the age of 18 in a sample of individuals from southeastern France. The studied sample consisted of OPTs 339 (184 females and 155 males) subjects aged between 14 and 22 years old. A logistic regression analysis with the adult age and minor age as dichotomous dependent variable and gender and I 3M as predictor variables showed that gender was not statistically significant in discriminating adults and minors. The receiver operating curve (ROC) analysis showed the best discrimination performance of the specific cut-off value of I 3M <0.08 in discriminating adults from minors. The proportion of accurate classification was 0.897 and 0.916 for females and males, respectively. The specificity (Sp) and sensitivity (Se) results for females were 0.962 and 0.813, respectively. Sp and Se for males were 0.953 and 0.871, respectively. The Bayes post-test probability was 0.961 and 0.955 in females and males respectively. Obtained results showed that a cut-off value of I 3M <0.08 may be an additional tool for indicating adult age in the tested population., (Copyright © 2018 Elsevier B.V. All rights reserved.)

This study aimed to assess the application of Cameriere's third molar maturity index (I 3M ) to select an individual of 18years or older (adult) from younger than 18years (minor) in a sample of Polish individuals. The final sample of 982 panoramic images aged between 15 to 24years was analyzed. The specific cut-off value of I 3M <0.08 was analyzed. The specificity (Sp) and sensitivity (Se) for males were 91.2% and 86.2% respectively. The Sp and Se for females were 93% and 82.6% respectively. The probabilities of correctly classified individuals were 87.6% and 85.3%, and Bayes post-test probability was 96.3% and 97% in males and females respectively. Further analysis indicated the alternative cut-off value of I 3M <0.07, which improved the specificity, 95.3%, and 94.7%, and worsen correct classification, 86.5%, and 84.4%, in males and females, respectively. Our results showed that the specific cut-off point of I 3M <0.08 may be a useful tool for discriminating adults from minors in Poland., (Copyright © 2018 Elsevier B.V. All rights reserved.)

This retrospective cross-sectional study has two-fold aims: the first is to assess new cut-offs at the legal age thresholds (LATs) of 14 and 16 years old and the second is to validate the cut-off of third molar index I 3M =0.08 for 18 years of age in Chilean people. Orthopantomographs from 822 Chilean children aged from 11 to 22 (472 girls and 350 boys) were analysed. For LAT of 14 years, cut-offs were found using the ROC curves singly for boys and girls. The cut-offs for boys were I 2M =0.16 and I 3M =0.73 while for girls we obtained I 2M =0.10 and I 3M =0.77. For LAT of 16 years we obtained the same cut-offs regardless of gender, which were 0.06 and 0.36 for I 2M and I 3M respectively. Concerning the validity of I 3M cut-off for 18 years old in Chilean population, the proportion of correctly classified individuals was 83% and estimated post-test probability, PPV, was 93.2%, with a 95% confidence interval equals to 91.3%, 94.6%. Hence, the probability that a subject positive on the test was 18 years of age or older was 93.2%, confirming the validation of the I 3M cut-off for Chilean population., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Radiological examination of the third molar is done in living individuals for estimation of chronological age, especially in the late adolescence. The aim of this study was to assess the application of Cameriere's third molar maturity index (I 3M ) to determine whether an individual is 18 years or older (adult) or younger than 18 years (minor) in a sample of Dutch individuals. The sample consisted of panoramic images of 360 individuals aged between 14 and 22 years old. Three observers performed the measurements. Gender was not statistically significant in discriminating adults and minors. The highest value of the Youden index of the receiver operating curve analysis was for the value of I 3M <0.08 in discriminating individuals as minor or adult. The specificity (Sp) and sensitivity (Se) results for females were 96.3% and 72.7% respectively. The Sp and Se for males were 95.0% and 84.0% respectively. The probabilities of correctly classified individuals were 83.3% and 88.9%, and Bayes post-test probability was 96.3% and 95.7% in females and males respectively. Obtained results showed that the specific cut-off point of I 3M <0.08 may be a useful and reliable method for adult age assessment in a Dutch population., (Copyright © 2017 Elsevier B.V. All rights reserved.)

In most countries, forensic age estimation in living subjects has become increasingly important in the last few years. In addition, as the age of legal majority ranges from 14 to 18 in many countries, and in Libya it is 18 years, radiographic assessment of the degree of third molar development is essential for forensic age estimation of adolescents and young adults. The aim of this paper is to assess the accuracy of the cut-off value of 0.08, by measurements of third molar index (I 3M ), in determining if a subject is adult or not in Libyan population. Digital panoramic radiographs of 307 healthy subjects (163 girls, 144 boys), aged between 14 and 22, were analysed. The I 3M, the age and the sex of the subjects were used as predictive variable for age estimation. Using a cut-off of 0.08, the sensitivity of the test for boys was 90.9% and the specificity 100%. The proportion of correctly classified individuals was 95.1% (95% CI: 91.5-98.7%). The sensitivity for girls was 90.6% and the specificity 100%. The proportion of correctly classified individuals was 94.5% (95% CI: 90.9-98.1%). Estimated post-test probability in boys and girls was 100%. Further analyses, performed using a cut-off of 0.09, do not affect the specificity (100%) while they improve the sensitivity for both boys and girls., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

According to Recommendation N°196 of the Australian Law Reform Commission (ALRC), the age at which a child reaches adulthood for the purposes of criminal law should be 18 years in all Australian jurisdictions. With specific reference to age at majority, the only tooth with development spanning adolescence (and thus the legally relevant 18 years of age) is the third molar, which limits the number of methods that can be applied from those available in the published literature. The aim of the present study is to test the accuracy of the third molar index (I3M=0.08), based on the correlation between chronological age and normalized measures of the open apices and height of the third mandibular molar, in order to assess the legal adult age of 18 years. Digital orthopantomographs of 143 living Australian subjects (72 boys and 71 girls) are analyzed. The results demonstrate that the sensitivity is 0.90 in boys and 0.90 in girls; associated specificity values are 0.85 and 0.87 respectively. We conclude that the cut-off value of I3M=0.08 is statistically robust and thus valid for forensic application in an Australian population., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

In the last few years, forced and unregistered child marriage has widely increased into Turkey. The aim of this study was to test the accuracy of cut-off value of 0.08 by measurement of third molar index (I3M) in assessing legal adult age of 18 years. Digital panoramic images of 293 Turkish children and young adults (165 girls and 128 boys), aged between 14 and 22 years, were analysed. Age distribution gradually decreases as I3M increases in both girls and boys. For girls, the sensitivity was 85.9% (95% CI 77.1-92.8%) and specificity was 100%. The proportion of correctly classified individuals was 92.7%. For boys, the sensitivity was 94.6% (95% CI 88.1-99.8%) and specificity was 100%. The proportion of correctly classified individuals was 97.6%. The cut-off value of 0.08 is a useful method to assess if a subject is older than 18 years of age or not., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

The aim of this cross-sectional study was to test the accuracy of cut-off value of 0.08 by measurement of third molar index (I3M) in assessing legal adult age of 18 years in a sample of Colombian children and young adults. Digital orthopantomographs of 288 Colombian children and young adults (163 girls and 125 boys), aged between 13 and 22 years, were analysed. Concordance correlation coefficient (ρc) and κ statistics (Cohen's Kappa coefficient) showed that repeatability and reproducibility are high for both intra- and inter-observer error. κ statistics for intra- and inter-observer agreement in decision on adult or minor was 0.913 and 0.877, respectively. Age distribution gradually decreases as I3M increases in both girls and boys. For girls, the sensitivity test was 95.1% (95% CI 87.1%-95%) and specificity was 93.8% (95% CI 87.1%-98.8%). The proportion of correctly classified individuals was 95.1%. For boys, the sensitivity test was 91.7% (95% CI 85.1%-96.8%) and specificity was 90.6% (95% CI 82.1%-97.8%). The proportion of correctly classified individuals was 89.7%. The cut-off value of 0.08 is highly useful to determine if a subject is 18 years of age or older or not., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

At the moment, a large number of asylum seekers from the Middle East are passing through Serbia. Most of them do not have identification documents. Also, the past wars in the Balkan region have left many unidentified victims and missing persons. From a legal point of view, it is crucial to determine whether a person is a minor or an adult (≥18 years of age). In recent years, methods based on the third molar development have been used for this purpose. The present article aims to verify the third molar maturity index (I3M) based on the correlation between the chronological age and normalized measures of the open apices and height of the third mandibular molar. The sample consisted of 598 panoramic radiographs (290 males and 299 females) from 13 to 24 years of age. The cut-off value of I3M=0.08 was used to discriminate adults and minors. The results demonstrated high sensitivity (0.96, 0.86) and specificity (0.94, 0.98) in males and females, respectively. The proportion of correctly classified individuals was 0.95 in males and 0.91 in females. In conclusion, the suggested value of I3M=0.08 can be used on Serbian population with high accuracy., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Estimation of chronological age of an individual is one of the main challenges in forensic science. Legally to be able to treat a person as a minor or an adult, it is necessary to determine whether their age of majority (if they are older or younger than 18, in most countries). Methods for estimating age are especially important when an individual in question lacks personal documents or other means of identification. As the dental age differs in various populations, the aim of this study was to evaluate applicability of third molar method for assessing age of majority in Croatia. Cameriere's third molar maturity index (I3M) value of 0.08, measured by the open apices of the teeth, was verified in sample of 1336 panoramic images aged between 14 and 23 years. Chronological age gradually decreased as I3M increased in both genders. Males showed statistically significant advanced maturation when I3M was between 0.0 and 0.3 value. The results indicate that the sensitivity of the test for 0.08 value was 84.3% (95%CI 80.6%, 87.5%) for females and 91.2% (95%CI 88.7%, 93.1) for males. Specificity was 95.4% (95%CI 92.5%, 97.5%) and 91.9% (95%CI 88.8%, 94.3%). The proportions of accurately classified males were 88.8% and that of females 91.5%. The estimated post-test probabilities, of individuals, in other word the probability that a Croatian individual with an I3M<0.08 is 18 years or older is 94.5% for females, and 96.5% for males. With high accuracy, the third molar maturity index should be used as a determinant of the age of majority in Croatia., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

The third molar tooth is one of the few anatomical structures in development available for estimating the age of individuals in the late adolescence. This study tests the accuracy of Cameriere's cut-off value of the third molar index (I3M) in assessing legal adult age of 18 years in an Albanian sample. For this purpose, a sample of orthopantomograms (OPTs) of 286 living subjects (152 female and 134 male) aged between 15 and 22 years was analyzed. Intra-rater and inter-raters agreement of I3M were 0.998 and 0.998, respectively and Cohen Kappa for intra-rater and inter-rater agreement in decision on adult or minor was 1.0 and 1.0, respectively. Age distribution gradually decreases as I3M increases in both males and females. The mean age of females is higher than that of males when I3M is between 0.04 and 0.08. Sensitivity test for males was 94.1%, with a 95% confidence interval (95% CI) 85.6-98.4%, and specificity was 90.9% (95%CI 81.3-96.6%). The proportion of correctly classified individuals was 92.5%, with a 95%CI of (86.7%, 96.4%). For females, the sensitivity test was 75.4%, with a 95%CI of (63.1%, 85.2%) and specificity was 96.6%, with a 95%CI of (90.3%, 99.3%). The proportion of correctly classified individuals was 87.5%, with a 95%CI of (81.2%, 92.3%). The results indicate that Cameriere's cut-off value of the third molar index (I3M=0.08) is useful in discriminating between Albanian adults and juveniles, and encourage us to test its suitability for determining the adult age in individuals from other populations., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

The aim of this cross-sectional study was to test the accuracy of Cameriere's European formula for age assessment in a large sample of Mexican children. The accuracy of dental age estimation was defined as how closely real age, measured as the difference between chronological age (CA) and dental age (DA), could be predicted. Digitalized orthopantomographs of 502 Mexican children (254 girls and 248 boys), aged between 5 and 15 years, were analyzed. The seven left permanent mandibular teeth were evaluated using Cameriere's method. Intra- and inter-observer variability for this technique was tested on a small random sample. Dental age was estimated for each individual and compared with known chronological age. Accuracy was measured as the difference between known chronological age and dental age and tested for significance with the mean prediction error (ME). The standard deviation and 95% confidence interval of the mean difference were also calculated. ME was 0.63 years for girls and 0.52 years for boys. ME was found to be slightly overestimated by 0.10 years for girls, but was correctly estimated for boys with an accuracy of 0.00. In conclusion, this method is very useful and may be recommended for practical application both in clinical dentistry and forensic procedures on the Mexican population., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Accurate age estimation has always been a problem for forensic scientists, and apposition of secondary dentine is often used as an indicator of age. Since 2004, in order to examine patterns of secondary dentine apposition, Cameriere et al. have been extensively studying the pulp/tooth area ratio of the canines by panoramic and peri-apical X-ray images. The main aim of this paper is to examine the relationship between age and age-related changes in the pulp/tooth area ratio in monoradicular teeth, with the exception of canines, by orthopantomography. A total of 606 orthopantomograms of Spanish white Caucasian patients (289 women and 317 men), aged between 18 and 75 years and coming from Bilbao and Granada (Spain), was analysed. Regression analysis of age of monoradicular teeth indicated that the lower premolars were the most closely correlated with age. An ANCOVA did not show significant differences between men and women. Multiple regression analysis, with age as dependent variable and pulp/tooth area ratio as predictor, yielded several formulae. R(2) ranged from 0.69 to 0.75 for a single lower premolar tooth and from 0.79 to 0.86 for multiple lower premolar teeth. Depending on the available number of premolar teeth, the mean of the absolute values of residual standard error, at 95% confidence interval, ranged between 4.34 and 6.02 years, showing that the pulp/tooth area ratio is a useful variable for assessing age with reasonable accuracy., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

One of the most interesting reasons for needing to estimate age in adult subjects is to ascertain the age of a person of questionable pensionable age. This problem is becoming increasingly important in Europe, owing to the high number of immigrants without valid birth certificates. The aim of this paper is to evaluate the application of the apposition of secondary dentine of canines by the method of Cameriere et al. [10], in order to estimate the pensionable age of subjects without proper birth certificates. Periapical X-rays of 180 canines from 90 subjects aged between 50 and 79, 46 men and 44 women, were analysed. Estimated ages were used to test the medico-legal question as to whether an individual was older or younger than 65 years of age. In subjects under 65, age was correctly evaluated in 91% and 89% of individuals using maxillary and mandibular canines, respectively. In subjects over 65, of pensionable age, estimates were correct in 85% and 88% of cases, respectively. The proportion of individuals with correct classifications was 89% for both maxillary and mandibular canines taken together. In only four subjects, the results of maxillary and mandibular canines were discordant; in the other 86 subjects, the test of maxillary and mandibular canines yielded concordant results. Among the latter, the proportion of individuals who were really aged 65 years or older, and who were correctly estimated as such, was 94%, and the proportion of individuals younger than 65 years of age who were correctly estimated as such was 96%., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

Carpals are often used as age indicators. In a recent study, Cameriere et al. studied the use of the ratio between the total area of carpal bones and epiphyses of the ulna and radius (Bo) and carpals (Ca) as age indicators. The present study, of a sample of 158 Slovenian children and adolescents aged between 6 and 16 years, focused on analysing the best regression for age estimation. The regression model yielded the following equation: age=-3.411+0.942 g+20.927(Bo/Ca), and explained 91.6% of total variance (R(2)=0.916). The median of the absolute values of residuals (observed age minus predicted age) was 0.09 years, with a quartile deviation of 0.786 years, and a standard error of estimate of 0.658 years. Comparisons between the previous equation referring to Slovenian children and the equivalent linear equation proposed by Cameriere et al. did not reveal any significant differences between the intercepts and slopes of the two linear models. These results suggested a common regression model for both Italian and Slovenian samples. The common regression model, describing age as a linear function of gender and Bo/Ca ratio, yielded the following linear regression formula: age=-2.907+0.408 g+20.757(Bo/Ca). This model explained 86% of total variance (R(2)=0.86). The median of the absolute values of residuals (observed age minus predicted age) was 0.02 years, with a quartile deviation of 1.02 years and a standard error of estimate of 0.96 years.

Age determination in living subjects is a problem of increasing interest in our community, due to the increasing numbers of individuals without identification papers, who have immigrated illegally or committed crimes, and for whom it is necessary to verify whether they have reached the age of 14 years in order to be charged legally. Although the most widespread methods for age estimation refer to skeletal or dental analysis, these methods do present some drawbacks for identification of the age of 14. The aim of the present study is to discriminate between children who are or are not 14 years of age or older by measuring the open apices of teeth. We evaluated the OPGs of 447 persons aged between 12 and 16 years, of Italian, Croatian and Slovenian nationality. For each individual, dental maturity was estimated using the number of the seven left permanent mandibular teeth with root development complete, and normalized measurement of the open apices of the third molar. The results revealed that an individual is considered to be 14 years of age or older if all seven left permanent mandibular teeth have closed apices and the normalized measurement of open apices of the third molar is lower than 1.1.

Estimation of skeletal age using radiographic images is widely used in assessing biological growth in clinical and auxological studies. The most frequently used areas for age estimation in children and adolescents are tooth and wrist/hand, both giving good results with only a low level of radiation. This pilot study of a sample of 150 Italian children and adolescents aged between 5 and 15 years focused on analyzing the possible applications of the proportion of carpal area (Ca) and teeth mineralization as a criterion of age estimation. The regression model, describing age as a linear function of gender (g), the ratio between carpal bones area and carpal area (Bo/Ca) and the measurement of open apices, yielded the following equation [Formula in text]. The model explained 93% of the total variance (R(2)=0.93), the median of the absolute values of residuals (observed age minus predicted age) was 0.465 years, with an inter-quartile range (IQR) equalling 0.529 years, and a standard error of estimate of 0.73 years.