Age estimation short.pptx. .

Age estimation

1. AGE ESTIMATION ZOYA SHAIKH 4 TH YEAR B.D.S 76

2. Who? Forensic anthropologist: Professional who applies the scientific methods and principles of physical anthropology to the legal process, particularly in the identification of human remains. Forensic odonatologist Professional who specializes in the application of dental knowledge to legal matters. Why?? Absent birth data is a big problem in our part of the world. Immigration Law suites Paediatricians and endocrinologists Competitive sports Final adult height of children

3. Types of age Anatomical Chronological Dental Mental Sexual Age estimation is the process of determining the age of an individual when their chronological age is unknown or disputed.

4. SKELETAL METHODS Geometrics Morphometrics in Craniofacial Cranial sutures Hand wrist Clavicle Femoral head iliac DENTAL METHODS Visual, R adiographic Morphological Chemical Histological Genetic and epigenetic

5. Skeletal methods

6. Geometrics Morphometrics in Craniofacial “Statistical shape method which can be used to quantify the biological forms in landmark-based analysis.”
craniofacial units such as 1.frontal sinus 2.palatal sutures 3. sphenooccipital synchondrosis 4.mandible
Detection of the morphological similarities or differences in a sample and the object is done
Landmarks are anatomically recognizable areas which are selected properly to capture the shape and is capable of being replicated. 
Semi landmarks can also be used https://pmc.ncbi.nlm.nih.gov/articles/PMC10319097/

7. Frontal sinus The ectocranial and endocranial table of the frontal bone separates forming an air pocket in the bone Ectocranial table is displaced anteriorly as the facial bones continue growth
Unlike the other sinuses, the frontal sinus is absent at birth
sinuses can begin forming in individuals as young as two years of age
they often are not visible radiographically until approximately six years of age
Growth ceases at about 20 years of age
Patricia ( Pediatric Radiology Interactive Atlas). https://pubmed.ncbi.nlm.nih.gov/28524272/

8. Palatal sutures Modified kamijo technique Obliteration score (OS) was obtained by measuring palatal suture obliteration The palatal sutures were divided into 14 sections, and each section was scored from 0 to 4 points according to the degree of the suture obliteration. 3. TSS: total suture score was used to perform regression analysis for age. The Mann et al. technique https://pubmed.ncbi.nlm.nih.gov/37137211/ https://link.springer.com/article/10.1007/s12024-023-00645-y

9. Sphenooccipital synchondrosis The SOS is a growth point on the cranial base that begins to close around the age of 10-11 years in females and 11-12 years in males.
This closure continues until it is completely fused, typically by the age of 17.
The SOS closure is scored in stages, from completely open (Stage 0) to completely fused (Stage 3) https://pubmed.ncbi.nlm.nih.gov/26832370/

10. Mandible 1. The mandibular body length, ramus height and mandibular length were increased by 2.23, 3.26, 4.26 mm/years respectively 2. Gonial angle
As age increases, decrease in gonial angle was found 3. Mandibular plane angle (MPA)
A decease of MPA in most is found about  −1.44 to 0.33° per year in males and −1.12 to 0.44° per year in females. https://pubmed.ncbi.nlm.nih.gov/22689354/ https://onlinelibrary.wiley.com/doi/10.5402/2013/453763 https://pmc.ncbi.nlm.nih.gov/articles/PMC6980205/

11. Cranial sutures Cranial sutures generally fuse with increasing age, although there is considerable variability in closure rates and patterns endocranial sutures are more reliable in estimating age than ectocranial sutures 1 Complete closure of Sagittal suture occurs at the age of 61 to 65 yrs , 2.Almost Complete closure of coronal suture occurs at the age of 56 to 60 yrs ,
3. Almost Complete closure of lambdoid suture occurs at the age of 66 to 70 yrs 4. Almost Complete closure of Temporoparietal suture occurs at the age of 66 to 70 yrshttps :// www.researchgate.net /publication/295255829_Age_estimation_from_cranial_sutures_-_a_Postmortem_study

12. Hand wrist method The hand-wrist method of age estimation involves  analyzing radiographs of the hand and wrist to determine the skeletal age of an individual.  1.The Atlas of Greulich and Pyle It is the most frequently used method  2.Tanner-Whitehouse (TW) Method Evaluates the development of the radius, ulna, and selected short bones (RUS).
3.Automated Methods: Computer-assisted methods, such as the Computer-Assisted Skeletal Age Score (CASAS) and the Computer-Aided Skeletal Maturity System (CASMAS) https://pmc.ncbi.nlm.nih.gov/articles/PMC6280566/ https://pmc.ncbi.nlm.nih.gov/articles/PMC3955574/

13. epiphysis of the middle phalanx of the third finger (MP3) follow an orderly sequence[ Hägg and Taranger ]

14. Clavicle(18 to 22 yrs ) Clavicle is the first long bone to start ossifying in fetal life
The ends ossify by endochondral ossification whereas the shaft ossifies via membranous ossification
During adolescence, uniquely, a secondary epiphyseal ossification center appears at the medial end of the clavicle that results in growth and remodeling of the bone
Complete fusion occurs at approximately 22 years
By the age of 18 years, hand ossification, third molar mineralization and sexual maturation are complete so hand radiography and dental age assessment are futile. 
Radiography of the clavicle is often plagued by overlapping shadows produced by structures of mediastinum, the vertebrae and the ribs. This results in inaccurate visualization of the medial epiphysis 

15. Iliac Crest(11 to 20yrs) The process of ossification and fusion of iliac bones has been studied in radiology extensively
The method used is called the Risser sign, which is based on the degree of maturation of the iliac crest apophysis However maturation is not uniform resulting in discrepancies while using this method for bone age calculation. This is why it is not used as a replacement of bone age calculation from hand radiographs. It only calculates the minimum age https://link.springer.com/article/10.1007/s00414-011-0554-9

16. Femoral head By assessing the depth of the epiphysial cartilage of femoral head which is continuously being ossified
When ossification is complete, most of the cartilage is replaced by bone and the remaining cartilage is called as the “hyaline articular cartilage”.
Involvement of articular cartilage in various juvenile diseases of the hip joint

17. Dental methods

18. Visual Visual observation of the sequence of eruption and morphological changes such as attrition, change in colour, etc. Are indicators of aging. 1. Evaluation of tooth eruption Eruption in oral cavity follows a typical chronological pattern. Can be used upto 12 to 13 years of age in correspondence to 2 nd molar eruption. 2. Tooth wear and attrition Tooth wear increases with age * Hongwei and Jingtao [23] classified tooth wear scores into a 0- to 9-point scale based on the pattern, number and amount of tooth wear *The Kim’s scoring system of tooth wear ● Calcification stages of teeth instead of eruption are preferred because tooth formation is proposed as more reliable criteria for determining dental maturation. ● Tooth wear is influenced by various factors that include functional (eating and chewing habits) orparafunctional habits, patterns of mandibular movement, bite force, saliva, diet, medication,diseases , geographical location, occupational and habitual environment and gender [21, 26

19. Radiographic 1. Tooth germs appearance
2. Beginning of mineralization both in the intrauterine life and after birth
3. Amount of crown completion
4. Eruption into the oral cavity
5. Degree of root completion of erupted or unerupted teeth 6. Degree of resorption of deciduous teeth
7. Measurement of open apices
8. Volume of pulp chamber and root canals/formation of physiological secondary dentine
9. Tooth-to-pulp ratio
10. Third molar maturity

20. In children and adolescents, the chronological age estimation based on dental maturation is mainly done either by using the atlas approach or by using scoring systems. ATLAS METHOD The radiographic dental mineralization is compared with dental atlases that include a series of drawings with outlines of developing teeth and eruption relative to a corresponding age in the atlas method. London atlas by AlQahtani , provides an age estimate for individuals aged 28 weeks in utero to young individuals up to 23 years, so it enables the usage of the third molar. In addition, it can be used in cases where sex cannot be determined, as it provides sex-specific and sex-neutral dental charts 2. SCORING SYSTEMS Demirjian method Determined only the dental maturity of the mandibular left seven permanent teeth (second molar to central incisors) based on eight tooth mineralization stages (“A "through “H”) on a panoramic radiograph Nollas method Can be applied to an individual with or without the third molar and that girls and boys are dealt with separately. It has 10 stages with 3 inter stage Options for each stage.

21. 1.Revised seven-tooth system [same teeth but withextended age ranges and two extra stages]; 2. four-teeth method [second molar (M2) to firstpremolar (PM1) inclusive]; and 3. Alternate four-teeth approach [the second incisive [12], firstpremolar [PM1], second premolar [PM2] and second molar [M2] [51, 52

22. Third molar calcification stage is one of the few tools that can be used to assess age development is nearing completion Harris and Nortje Van Heerden Mature teeth cannot be used to estimate age because the time they completed developmental stages is unknown thus other methods are used 1.Coronal pulp cavity index Calculates the correlation between the reduction of the coronal pulp cavity and the chronological age. Only mandibular premolars and molars were considered on panoramic radiographs. where CPCH is the length of the coronal pulp cavity and CL is the length of the tooth crown

23. 2. Pulp-to-tooth ratio method by Kvaal Kaavl c alculated the pulp-tooth ratio for six mandibular and maxillary teeth, determines age of 18 and more. Age is derived by using pulp-to-tooth ratios in the formula: Software program named Dental Age Estimation®has been developed toautomate the dental age calculati .

24. Once dental development is complete, developmental stages could not be used for age estimation instead the indicators showing that dental structures undergo changes through life are being used. Morphological methods are based on assessment of ex-vivo teeth for age estimation Gustavson , Dalitz , Bang and Ramm , Johanson , Maples and Solheim GUSTAVSON’S METHOD He described the morphological changes occurring in the dental tissues by increasing age and noted the following changes: Attrition of the incisal or occlusal surfaces due to mastication [A] Periodontitis [P]—the loss of periodontal attachment Secondary dentin [S]—the amount of coronal secondary dentine formation Cementum apposition [C] at the root apex Root resorption [R] amount f. Transparency of the root [T] Each criterion was ranked and allotted 0, 1, 2 and 3 points. The score values of each age change are added according to the following formula Morphological

25. Prenatal stage, up to 6 months, radiological methods cannot be accurate in dental age estimation given that the dentin and enamel images are radiolucent. 1.Stack’s method It is suitable to overcome this restriction. It was demonstrated that the dry weight of the mineralized tooth cusps gives an approximate age of the child by using gravimetric methods. Fetal age is linearly related to the square root of the weight of mineralized tissue in the deciduous anterior teeth during the last trimester 2.Aspartic acid racemization Levels of D-aspartic acid in human enamel, dentine and cementumincrease with age. The D/ Lratio has been shown to be highly correlated with age Cementum shows the fastest reaction but dentine showed the highest correlation with actual age. Biochemical

26. Histological MINERALIZATION Prenatal dental maturity can be assessed by using dissection and alizarin staining of fetal tooth germs. Initiation of mineralization, as visualized by alizarin staining, takes place in the first permanent molars between 28 and 32 fetal weeks with the mandibular germs being slightly in advance than those of the maxilla. 2. NEONATAL LINE Estimates the period of survival of an infant in perinatal period using neonatal line as a line of reference and can give the exact age of the baby in days. It also differentiate between live birth and still birth 3.CEMENTUM ANNULATIONS Incremental lines in the tooth cementum can be used as a marker for age.

27. https://www.researchgate.net/publication/323180799_Defining_Dental_Age_for_Chronological_Age_Determination https://pmc.ncbi.nlm.nih.gov/articles/PMC5512405/ https://pmc.ncbi.nlm.nih.gov/articles/PMC5512405/ https://pmc.ncbi.nlm.nih.gov/articles/PMC8859581/ https://pmc.ncbi.nlm.nih.gov/articles/PMC4080060/ https://forensicreader.com/age-estimation-from-teeth/ https://bmcoralhealth.biomedcentral.com/articles/10.1186/s12903-022-02652-x