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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 9  |  Issue : 3  |  Page : 180-184

Comparison of the London Atlas method with Cameriere's method of age estimation in South Indian children


Department of Pediatric and Preventive Dentistry, Kannur Dental College, Kannur, Kerala, India

Date of Submission26-Oct-2022
Date of Decision18-Nov-2022
Date of Acceptance21-Nov-2022
Date of Web Publication31-Dec-2022

Correspondence Address:
Dr. Sruthi Chandran
Department of Pediatric and Preventive Dentistry, Kannur Dental College, Kannur, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjoralsci.sjoralsci_47_22

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  Abstract 


Introduction: Age estimation is an essential component of forensic science where age is a factor. Dental age is regarded as a reliable, simple, and quick method of determining age in children. The London Atlas of human tooth development and eruption is a recently proposed age estimation method.
Aim: The present study aimed to evaluate and compare the accuracy of the London Atlas of tooth Development with Cameriere's method of age estimation in relation to chronological age.
Materials and Methods: Panoramic radiographs of 200 healthy individuals between 5 and 15 years were assessed using the simple sampling method. The chronological ages were recorded based on the data on the medical records. The data obtained were analyzed using the SPSS software version 22.0 and expressed in terms of mean and standard deviation.
Results and Discussion: The results show that there is no statistically significant difference (P < 0.05) between the data were obtained for London Atlas age estimation and Cameriere's method. The London Atlas method is easier in calculating as it is a software-based program.
Conclusions: The London atlas method of age estimation is an accurate method of age estimation in the South Indian population.

Keywords: Age estimation, cameriere method, chronological age, London atlas method, orthopantomograph


How to cite this article:
Peedikayil FC, Chandran S, Kottayi S, Purakkal AT, Aravind A, John S. Comparison of the London Atlas method with Cameriere's method of age estimation in South Indian children. Saudi J Oral Sci 2022;9:180-4

How to cite this URL:
Peedikayil FC, Chandran S, Kottayi S, Purakkal AT, Aravind A, John S. Comparison of the London Atlas method with Cameriere's method of age estimation in South Indian children. Saudi J Oral Sci [serial online] 2022 [cited 2023 Feb 6];9:180-4. Available from: https://www.saudijos.org/text.asp?2022/9/3/180/366530




  Introduction Top


Age estimation is not only an essential component of forensic science but also in the timings of dental treatment procedures in children. In many circumstances, age estimation is a fundamental organizing principle when concerns are there in age-related participation in sports and in legal aspects such as child labor. As pediatric dentistry, various specialties such as orthodontics and endocrinology need precise age data to establish the exact timing of the treatment procedure.[1]

Dental age is regarded as a reliable, simple, and quick method of determining age in children since there is limited variability due to the teeth calcification rate. Furthermore, teeth are the most indestructible mineralized structures that can last for many years, making tooth examination the most trustworthy method of age assessment.[2] Edwen Sauder's was the first published information about teeth “as a test of age” in 1837. Since then, many morphological, biochemical, and radiographical methods have been used to assess dental age, such as Schour and Masseler method, Nolla's method, Moore's, Fanning and Hunt method, Cameriere's method, Demirjian, Goldstein, Tanner method and Williem's modification, etc.[3]

The radiographic method of age estimation is a cost-effective, simple imaging procedure that provides an excellent overview of dental maturity.[4] Most commonly used radiographic age estimation method is the Demirijians method. However, studies have shown that overestimation of age can occur by this method.[1] Moreover; it requires seven mandibular left side teeth and cannot apply in children with hypodontia. In 2006, Cameriere et al. proposed a radiographic method for the age estimation in the European population which is reliable and more accurate than other methods.[5] Another relatively new method is the London Atlas age estimation method. It is done by using a software program that can be downloaded. The pioneers of the program claim it is comprehensive evidence-based program for estimating age using both tooth development and alveolar eruption in age between 28 weeks in utero.[6]

Very few studies are in the literature comparing the accuracy of the London Atlas method with other methods, especially in the Indian population. Therefore, the present study was carried out to estimate the accuracy of the London Atlas of tooth development with Cameriere's formula in assessing the actual age of South Indian population.


  Materials and Methods Top


This retrospective study was conducted in the pediatric dentistry department of a dental college by using the orthopantomographs of 200 children. The sample size was calculated using an online software G * Power version 3.1with 80% power and a 5% significance level.

The sample size calculated was 192 subjects which were rounded off to 200. The inclusion criteria were clear digital radiographs of children between 5 and 15 years. Poor quality unclear radiographs, radiographs of patients with pathology, developmental defects, and grossly destructed teeth were excluded. A convenient sampling method was employed. All the OPGs were recorded by a single orthopantomogram machine (Planmeca Proline EC Panoramic X-ray). The chronological ages were recorded based on the date on medical records.

Dental age estimation methods

London atlas of tooth development method

OPGs were evaluated to assess the development phases for all permanent teeth on the right side of both the upper and lower jaws. The individual's dental age was determined using software provided on the website: http://www. atlas. dentistry. qmul. ac. uk. After entering the patients' details, the chart given in the website was filled by matching the stages of tooth development and alveolar eruption in the OPG with that of the pictures given in the website for specific tooth. After entering the patients' details, the chart given in the website can be filled by matching the stages of tooth development and alveolar eruption in the OPG with that of the pictures given in the website for specific tooth. Thereafter , the dental age will be automatically displayed by the software.

Cameriere method

The seven right permanent mandibular teeth were assessed after obtaining the OPGs. The number of teeth with complete root development or closed apical ends of the root was calculated as (N0). The teeth with incomplete root development or open apices were considered and the distance between the inner sides of the open apex was measured as Ai (where i = 1, 2, −7 the number of the tooth). In the case of teeth with multiple roots, the sum of the distances between the inner sides of the two open apices was evaluated (e.g., A6 = A6a + A6b). To avoid magnification and angulation errors, measurements were normalized by dividing the tooth length (Li, where i = 1, 2,-7) [Figure 1]. Finally, the dental maturity score for each tooth was obtained by calculating the Xi where (Xi = Ai/Li, where i = 1, 2, −7). The sum of all the normalized open apices is represented as 'S' where (S = X1 + X2 + X3 + X4 + X5 + X6 + X7). Further, all these values were substituted in the Indian-specific formula given by Cameriere et al., which is:[age = 9.402 − 0.879c + 0.663N0 − 0.711s − 0.106SN0] where 'c' is a dummy variable that denotes '1' for the South Indian population.
Figure 1: Cameriere's method of measuring open apices and tooth length

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The obtained data from both age estimation methods were analyzed using the SPSS (Statistical Package for the Social Sciences) software, version 22.0 (IBM corporation, Chicago, IL, USA) and expressed in terms of mean and standard deviation. Dental age (Estimated age) was subtracted from the chronological age (Actual age): a positive result indicated underestimation and a negative one indicated overestimation.

Ethical Committee

The study was approved by Institutional Ethics Committee of Kannur Dental College (KDC/pedo20/SS-18).


  Results Top


[Table 1] shows the group distribution of the OPGs and gender cross-tabulation. Out of 200 OPGs, 99 (49.5%) were male and 101 (50.5%) were female.
Table 1: Group and gender description of participants

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[Table 2] compares the chronological age, London Atlas age estimation, and Cameriere Age estimation. The chronological mean age for males was 9.27 years. The estimated mean age through the London Atlas Age method was 9.35 years, and Cameriere Method was 9.31, which, on comparison, showed nonsignificant results with a P = 0.880 and 0.806, respectively. The chronological mean age for females was 9.71 years. The estimated mean age through the London Atlas Age method was 9.52 years, and Cameriere method was 9.47 which on comparison, showed nonsignificant results with a P = 0.696 and 0. 597, respectively.
Table 2: Comparison of chronological age, London Atlas age estimation, and Cameriere age estimation

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[Table 3] shows the mean comparison of chronological age with the London atlas age estimation. The chronological mean age was 9.480 ± 2.4411, whereas London Atlas mean age was 9.430 ± 2.4995. Independent t-test was used to compare the chronological age with London atlas age estimation and it was observed that there was no statistical significant difference between chronological age and London atlas age estimation.
Table 3: Independent samples test for chronological age with London atlas age estimation

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[Table 4] shows the mean comparison of chronological age with Cameriere age estimation.
Table 4: Independent samples test for chronological age with Cameriere age estimation

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The chronological mean age was 9.20 ± 2.27, whereas Cameriere's mean age was 9.38 ± 2.50.

Independent t-tests were used to compare chronological age with Cameriere age estimation and was observed that there was no statistical significant difference between Chronological age and Cameriere age estimation.


  Discussion Top


Skeletal and sexual maturity indexes have been used to determine age in children. However, dental age estimation approaches have lately gained popularity because they are less variable or influenced as maturity markers.[7] The dental age is a sort of developmental age that is reasonably well related to an individual's actual age, and it is a frequent practice due to its ease of usage.[8] The present study compared the London Atlas with Cameriere's age estimation method of the South Indian population of children aged 5–15 years.

Cameriere's method when compared with Willems and Demirjian's method was found to be more reliable and precise method for age assessment in young children.[9] The variables “gender,” “N0,” and “s” played a significant part in the formula unique to Europeans. India has varied ethnic, socioeconomic, and dietary factor which has an impact on a child's development. Because of the considerable ethnic heterogeneity in the Indian population, the same European formula could not be employed. Thus, the emphasis was placed on the country's area, denoted as “c” in the Indian formula, to have a substantial correlation with age estimation. As a result, in the Indian formula, the variable “c,” is an essential factors in the age estimation formula.[7] In the present study, C is taken as one as in a study by Pratyusha et al.[10]

Only one study compared Cameriere's method and the London atlas method among the Indian population. Bagh et al.,[11] in a study on the North Indian population, showed that both Cameriere and London atlas age estimation methods correlate with the chronological age. Our results also showed no statistically significant difference between the London Atlas of age estimation method and the Cameriere method in the South Indian population.

Contrary to our findings, Alshihri et al.[12] studies on Saudi children showed a significant difference between the dental and actual age of the subjects when the London Atlas was used for age estimation.

Another study done in the Saudi population by Alsudairi et al.[13] found that the London atlas of age estimation method was more accurate than the Cameriere method, which had an overestimation of age in males and females in Cameriere method.

In the present study, when the chronological age was compared with the estimated age in males and females, nonsignificant results were obtained. The results are under the studies conducted by Bagh et al.[11] and Vadla et al.[7] Similarly, Pavlović et al.[14] also found a nonsignificant differences between male and female subjects in a study on the Portuguese population. A study done by Javadinejad et al.[15] showed that overestimation of age in males by the Cameriere method.

The London Atlas of Human Tooth Development uses tooth development stage and alveolar eruption level to predict age. When the London Atlas was compared to the Schour and Massler estimation chart and the Ubelaker estimation chart, it was found to be reasonably accurate, and there was no substantial difference for most age groups. The researchers observed most minor variability during childhood.[16] Alqahtani et al.[2] compared the London Atlas to Schour and Massler's and Ubelaker's age estimation charts from 0 to 23-year-old individuals. They found that London Atlas was the most accurate.

The London Atlas method produced a nonsignificant difference, showing that it is a more accurate technique. It offers many advantages, including the use of upper and lower jaws, the inclusion of both deciduous and permanent dentition developmental stages, and the observation of the degree of the alveolar bone eruption of the teeth, all of which indicate that it is more accurate.[14] In the London Atlas, age is expressed in a range rather than as a definite number. In contrast, Cameriere's measurements provide a point estimate that suggests a fundamental difference between the estimated and actual ages. As a result, the London Atlas has a higher chance of 6-month inaccuracy, and the difference between anticipated and actual age may be exaggerated.[13]

Literature reports show limitations for Atlas-based methods like overlapping maturity stages, lack of sex differentiation, propensity for higher interobserver disagreement, and errorrates than other tooth formation and development assessment techniques.[12]

The limitations of the study are that we could not obtain an even sample distribution for age and gender for the participants in this study and some group may be under represented. The age group considered in this study is 5–15 years. Therefore, the assessment of age estimation and the suitability of London Atlas method based on third molars could not considered.


  Conclusions Top


The London Atlas and Cameriere's method can accurately estimate a South Indian individuals' dental age. Cameriere's method necessitates additional mathematical calculations, whereas the London Atlas requires simply a visual comparison of the panoramic image with the atlas. The London Atlas is also made easier to use by a free software program. As a result, the atlas is suggested as a simple and accurate approach for the South Indian population.

More studies have to be done in various communities with specific races and ethnicity for it to be considered as the ideal method of age estimation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Chandramohan P, Puranik MP, Uma SR. Demirjian method of age estimation using correction factor among Indian children: A retrospective survey. J Indian Assoc Public Health Dent 2018;16:72.  Back to cited text no. 1
  [Full text]  
2.
AlQahtani SJ, Hector MP, Liversidge HM. Accuracy of dental age estimation charts: Schour and Massler, Ubelaker and the London Atlas. Am J Phys Anthropol 2014;154:70-8.  Back to cited text no. 2
    
3.
Kış HC, Görürgöz C, Başol M, Canger EM, Öztaş B. Evaluation of the Willems and Cameriere's dental age estimation methods in Turkish children – A modified version of Cameriere's method. Forensic Sci Int Rep 2020;2:100105.  Back to cited text no. 3
    
4.
Butti AC, Clivio A, Ferraroni M, Spada E, Testa A, Salvato A. Häävikko's method to assess dental age in Italian children. Eur J Orthod 2009;31:150-5.  Back to cited text no. 4
    
5.
Hostiuc S, Diaconescu I, Rusu MC, Negoi I. Age estimation using the Cameriere methods of open apices: A meta-analysis. Healthcare (Basel) 2021;9:237.  Back to cited text no. 5
    
6.
Sharma P, Wadhwan V. Comparison of accuracy of age estimation in Indian children by measurement of open apices in teeth with the London atlas of tooth development. J Forensic Odontostomatol 2020;1:39-47.  Back to cited text no. 6
    
7.
Vadla P, Surekha R, Rao GV, Deepthi G, Naveen S, Kumar CA. Assessing the accuracy of Cameriere's Indian-specific formula for age estimation on right and left sides of orthopantomogram. Egypt J Forensic Sci 2020;10:1-6.  Back to cited text no. 7
    
8.
Ghafari R, Ghodousi A, Poordavar E. Comparison of the accuracy of the London atlas and smith method in dental age estimation in 5-15.99-year-old Iranians using the panoramic view. Int J Legal Med 2019;133:189-95.  Back to cited text no. 8
    
9.
Cameriere R, Ferrante L, Liversidge HM, Prieto JL, Brkic H. Accuracy of age estimation in children using radiograph of developing teeth. Forensic Sci Int 2008;176:173-7.  Back to cited text no. 9
    
10.
Pratyusha K, Prasad MG, Radhakrishna AN, Saujanya K, Raviteja NV, Chandrasekhar S. Applicability of Demirjian's method and modified Cameriere's methods for dental age assessment in children. J Clin Diagn Res 2017;11:C40-3.  Back to cited text no. 10
    
11.
Bagh T, Chatra L, Shenai P, Veena KM, Rao PK, Prabhu VR, et al. Age estimation using Cameriere's seven teeth method with Indian specific formula in south Indian children. Int J Adv Health Sci 2014;1:2-10.  Back to cited text no. 11
    
12.
Alshihri AM, Kruger E, Tennant M. Dental age assessment of Western Saudi children and adolescents. Saudi Dent J 2015;27:131-6.  Back to cited text no. 12
    
13.
Alsudairi DM, AlQahtani SJ. Testing and comparing the accuracy of two dental age estimation methods on Saudi children: Measurements of open apices in teeth and the London atlas of tooth development. Forensic Sci Int 2019;295:226.e1-226.e9.  Back to cited text no. 13
    
14.
Pavlović S, Palmela Pereira C, Vargas de Sousa Santos RF. Age estimation in Portuguese population: The application of the London atlas of tooth development and eruption. Forensic Sci Int 2017;272:97-103.  Back to cited text no. 14
    
15.
Javadinejad S, Sekhavati H, Ghafari R. A comparison of the accuracy of four age estimation methods based on panoramic radiography of developing teeth. J Dent Res Dent Clin Dent Prospects 2015;9:72-8.  Back to cited text no. 15
    
16.
AlQahtani SJ, Hector MP, Liversidge HM. Brief communication: The London atlas of human tooth development and eruption. Am J Phys Anthropol 2010;142:481-90.  Back to cited text no. 16
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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