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

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.