Original communicationTwo new oro-cervical radiographic indexes for chronological age estimation: A pilot study on an Italian population
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.
References (33)
- et al.
Age estimation of unaccompanied minors. Part II. Dental aspects
Forensic Sci Int
(2006) - et al.
Age estimation using carpals: study of a Slovenian sample to test Cameriere's method
Forensic Sci Int
(2008) - et al.
The problem of aging human remains and living individuals: a review
Forensic Sci Int
(2009) - et al.
An example of regional variation in the tempos of tooth mineralization and hand-wrist ossification
Am J Orthod Dentofacial Orthop
(1992) - et al.
Dental age estimation utilizing third molar development: a review of principles, methods, and population studies used in the United States
Forensic Sci Int
(2010) - et al.
Human third molars development: comparison of 9 country specific populations
Forensic Sci Int
(2010) - et al.
Accuracy of age estimation of radiographic methods using developing teeth
Forensic Sci Int
(2006) - et al.
The cervical vertebral maturation (CVM). Method for the assessment of optimal treatment timing in dentofacial orthopedics
Semin Orthod
(2005) Physical changes of puberty
Endocrinol Metab Clin North Am
(1991)- et al.
Age assessment by the Greulich and Pyle method compared to other skeletal X-ray and dental methods in data from Finnish child victims of the Southeast Asian Tsunami
Forensic Sci Med Pathol
(2011)
Assessing chronological age of unaccompanied minors in Southern Italy
Am J Forensic Med Pathol
A new system of dental age assessment
Human Biol
Radiographic atlas of the skeletal development of the human hand and wrist
Demirjian's system for estimating the dental age of northeastern Brazilian children
Forensic Sci Int
Brief communication: the London atlas of human tooth development and eruption
Am J Phys Anthropol
Cited by (7)
A decade of development in juvenile aging
2017, New Perspectives in Forensic Human Skeletal IdentificationCorrelating skeletal and dental developmental stages using radiographic parameters
2016, Journal of Forensic and Legal MedicineCitation Excerpt :The present study aimed to associate the developmental stages of cervical vertebrae and teeth using lateral cephalometric and panoramic radiographs, respectively. Both the cervical vertebrae and the human teeth were already used in previous studies,9,21 which combined developmental parameters towards the optimization of age estimation outcomes. In specific, the implementation of cervical vertebrae development, assessed through the technique of Bacetti et al.16 in the third molars age estimation procedure performed using Köhler et al.22 resulted in great improvement of outcomes for the early phase of dental development.9
Radiographic evaluation of dental and cervical vertebral development for age estimation in a young Brazilian population
2018, Journal of Forensic Odonto-StomatologyAre cervical vertebrae suitable for age estimation?
2017, Journal of Forensic Odonto-StomatologyFive radiographic methods for assessing skeletal maturity in a Spanish population: is there a correlation?
2017, Acta Odontologica ScandinavicaDevelopmental Juvenile Osteology: Second Edition
2016, Developmental Juvenile Osteology: Second Edition