Original communication
Two new oro-cervical radiographic indexes for chronological age estimation: A pilot study on an Italian population

https://doi.org/10.1016/j.jflm.2013.06.021Get rights and content

Abstract

Chronological age (CA) plays a fundamental role in forensic dentistry (i.e. personal identification and evaluation of imputability). Even though several studies outlined the association between biological and chronological age, there is still great variability in the estimates. The aim of this study was to determine the possible correlation between biological and CA age through the use of two new radiographic indexes (Oro-Cervical Radiographic Simplified Score – OCRSS and Oro-Cervical Radiographic Simplified Score Without Wisdom Teeth – OCRSSWWT) that are based on the oro-cervical area. Sixty Italian Caucasian individuals were divided into 3 groups according to their CA: Group 1: CAG 1 = 8–14 yr; Group 2: CAG 2 = 14–18 yr; Group 3: CAG 3 = 18–25 yr; panorexes and standardised cephalograms were evaluated according Demirjian's Method for dental age calculation (DM), Cervical Vertebral Maturation method for skeletal age calculation (CVMS) and Third Molar Development for age estimation (TMD). The stages of each method were simplified in order to generate OCRSS, which summarized the simplified scores of the three methods, and OCRSSWWT, which summarized the simplified DM and CVMS scores. There was a significant correlation between OCRSS and CAGs (Slope = 0.954, p < 0.001, R-squared = 0.79) and between OCRSSWWT and CAGs (Slope = 0.863, p < 0.001, R-squared = 0.776). Even though the indexes, especially OCRSS, appear to be highly reliable, growth variability among individuals can deeply influence the anatomical changes from childhood to adulthood. A multi-disciplinary approach that considers many different biomarkers could help make radiological age determination more reliable when it is used to predict CA.

Introduction

Chronological age (CA) plays a fundamental role in forensic dentistry. The evaluation of imputability (i.e., defendants or illegal immigrants without identification documents) is the most important emerging fields in which CA determination can have a large impact.1, 2, 3 During legal trials in which a supposed minor who does not possess identifying documents is involved, the court needs to ascertain the defendant's exact CA to determine imputability. The court usually requests an expert, such as a forensic doctor or an auxologist, to establish the CA of the defendant. The methods routinely used to determine CA are mainly based on the determination of biological age (i.e., dental or bone age), which, unfortunately, can only predict CA. Even though several studies outlined the association between biological and chronological age, and some notable recommendations have been published, there is still great variability in the estimates.4, 5, 6, 7, 8, 9, 10, 11

Italian law considers CA to be an essential requirement for imputability. To this end, three major CA groups are classified as follows12:

  • -

    individuals younger than 14 years are not imputable;

  • -

    for individuals between 14 and 18 years, the imputability must be established on a case-by-case basis through psychiatric evaluation (doli incapax test);

  • -

    individuals older than 18 years are imputable, unless there are pathological circumstances that impair mental and physical integrity.

Furthermore, Italian law provides a 24-hour period to determine CA. Because the defendant is considered to be the CA at which one receives the more lenient punishment, it is absolutely necessary to perform all identification procedures in the shortest amount of time.12

Determining the CA through the assessment of biological age using radiographic growth parameters (i.e., the hand and wrist skeletal development atlas6 and Demirjian's method for dental age calculation5) is the most widely used method. The growth of the stomatognatic region has been frequently advocated as a precise marker of biological age, particularly from birth to puberty (12–14 years old). Tooth development was initially thought to be slightly influenced by the environment and diseases; nevertheless, great differences in tooth development were observed among individuals of the same age living in the same country but in different regions.13, 14, 15 Furthermore, after puberty, age determination can be only performed by considering third molar development, which is associated with substantial variance (i.e., absence, malformed and high variability for the degree of maturation).16, 17, 18, 19, 20, 21

Even though radiographic methods are used most frequently, many studies have failed to determine a precise correlation between biological age and CA. Moreover, these methods define an age range of the defendant; therefore, the practical application according to Italian law implies that the defendant could be assigned to two different imputability-CA groups, and may thus be eligible for two different legal procedures. For instance, a defendant could be identified as being between 17 and 19 years old. In this situation, Italian law considers the defendant to be the CA at which the more lenient sentence is administered.1, 2, 3, 7, 8, 9, 22, 23, 24

The aim of this study was to determine the possible correlation between biological age and CA through the use of two new radiographic indexes; these are based on the combination of already validated biological age calculation methods performed on the oro-cervical area in an Italian population with the purpose of determining the imputability of supposed minors without age identifying documents. The first method, called Oro-Cervical Radiographic Simplified Score (OCRSS), is based on the combination and simplification of three already established radiographic indexes:

  • A.

    Demirjian's Method for dental age calculation (DM)5

  • B.

    Cervical Vertebral Maturation method for skeletal age calculation (CVMS)25

  • C.

    Third Molar Development for age estimation (TMD)26

The second method, referred to as Oro-Cervical Radiographic Simplified Score Without Wisdom Teeth (OCRSSWWT), is derived from the combination and simplification of only two of the above mentioned indexes: DM and CVMS.

The OCRSS index assessed the accuracy of the correlation between this new oro-cervical index and CA under the best radiographic and anatomical conditions; the OCRSSWWT index assessed the accuracy of the correlation when only two oro-cervical biological age indexes were available (when the third molar was missing) and the possible contribution of CVMS when TMD could not be used.

Section snippets

Materials and methods

Sixty Italian Caucasian individuals (21 males, 39 females; Table 1), all belonging to middle class socioeconomic status, were retrospectively enrolled among orthodontic outpatients of the Dental Clinic (Catholic University, Rome), in two years study (2010–2012). The patients were divided into 3 groups according to their chronological age: Group 1: CAG 1 = 8–14 yr; Group 2: CAG 2 = 14–18 yr; Group 3: CAG 3 = 18–25 yr. One researcher, with at least 3 years of orthodontic experience, blindly

Results

Characteristics of the population are reported in Table 1. The stratified population based on OCRSS and OCRSSWWT is also reported in Table 1.

Discussion

The aim of this study was to evaluate an easy, fast and reliable tool for CA determination, particularly to determine the imputability of an individual who possesses no age-identifying documents or the age of asylum-seeking immigrants. The need for such a tool is crucial because in many European Union Countries (EU), and particularly in the Mediterranean Area (i.e., Italy, Malta, Greece, and Spain), illegal immigration fluxes are a major concern. Due to its key geographical position, Italy is a

Conclusions

The new indexes, especially OCRSS, have proven to be easy, fast and reliable tools for CA determination, particularly to determine the age of individuals who possess no age-identifying documents or the age of asylum-seeking immigrants, nevertheless a multi-disciplinary approach that considers many different biomarkers could help make radiological age determination more reliable when it is used to predict CA.

Ethical approval

Not needed.

Funding

This work was supported, in part, by Fondi di Ateneo Linea D1, Università Cattolica del Sacro Cuore - Roma (A.O.)

Conflict of interest

There are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome.

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