my forensic odontology ppt

1. DR G KIRAN KUMAR
ASSOCIATE PROFESSOR, ORAL PATHOLOGY
GOVT DENTAL COLLEGE & HOSPITAL,
HYDERABAD
APPLICATION NO. STMAR191027002
kiran.dentist@gmail.com
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3. INTRODUCTION
 Age of majority- Medicolegal cases
 Juvenile Justice Act 2000 of UN-Age of criminal responsibility at 18
years
 Study Group on Forensic Age Diagnostics (AGFAD) criteria for
Age estimation:
A. Physical examination,
B. Anthropometric measures,
C. Radiological examination of left hand or CT of the Clavicle and
D. Dental examination with radiologic analyses of the dentition
 Cameriere’s 3rd molar maturity index
 Pulp space visibility
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4. AIMS & OBJECTIVES
To validate and compare third molar maturity index and pulp space
visibility for predicting the age of majority.
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5. MATERIALS & METHODS
 Retrospective study; 615 digital OPGs, 15 to 22 years.
 All the analysis were performed using a blind approach with the
readers not aware of age of the patients.
 Left mandibular 3rd molars according to Cameriere et al.
 Chronological age-Difference between the date of exposure and
the date of birth -converted into decimal ages.
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6. Inclusion criteria:
1. Subjects between 15 and 22 years,
2. Subjects whose DOB was known
3. Good quality radiographs
4. Subjects without systemic diseases which can affect growth
(hypothyroidism etc.)
Exclusion criteria:
1. Subjects with unknown birth dates
2. Subjects with missing third molars, severe caries, fillings
3. Subjects with developmental anomalies
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7. Cameriere’s 3rd molar maturity index
 IMAGE J SOFTWARE was
used
 If the root development of
the third molar is complete
(apical ends of the roots are
completely closed)- I3M is
zero.
 If not, I3M is the sum of the
distances between the inner
sides of the two open apices
divided by the tooth length.
 Cut-off value of I3M < 0.08
was applied for validation CC BY-SA-NC

8. Pulp space visibility (Olze et al.)
1. Stage 0 = the lumen of all root canals is visible all the way to apex.
2. Stage 1 = the lumen of one root canal is not fully visible to the apex.
3. Stage 2 = the lumen of two root canals are not fully visible to the apex,
or one canal may be virtually invisible in full length.
4. Stage 3 = the lumen of two root canals is virtually invisible in full length.
Visibility of the root pulp of the lower third molars with
completed root formation with apical closure was recorded in
four stages
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9. RESULTS
Table 1: Age and Gender distribution of the sample
Age Range Males Females Total
15-15.9 52 63 115
16-16.9 36 53 89
17-17.9 47 53 100
18-18.9 41 59 100
19-19.9 50 73 123
20-20.9 23 37 60
21-21.9 11 17 28
Total 260 355 615
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10. Figure 1: Boxplot showing the relationship between third molar
maturity index (I3M ) and age groups of mandibular left third molar
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11. Table 2: Test of diagnostic accuracy of I3M <0.08
TEST
I3M<0.08
DIAGNOSIS SENSITIVITY SPECIFICITY
TP FP TN FN (95% CI) (95% CI)
MALES 99 36 95 30 0.76 (0.68-0.83) 0.82 (0.74-0.89)
FEMALES 131 38 122 64 0.77 (0.70-0.83) 0.86 (0.78-0.92)
OVERALL 230 74 217 94 0.765 (0.70-0.80) 0. 84 (0.79-0.89)
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12. Table 3: Statistical data on the age (in years) of the stages of
root pulp visibility of 38, by stage in females and males (N=352)
Gender Stage Number Min Max Mean SD
FEMALES 0 57 16.22 20.43 17.69 1.1
1 118 16.76 20.81 19.11 0.8
2 26 18.14 20.99 19.91 0.7
MALES 0 60 16.08 20.91 17.86 1.2
1 69 17.01 20.69 18.98 0.8
2 22 17.42 20.95 19.73 0.8
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13. Test 4: Tests of diagnostic accuracy
TEST
0
DIAGNOSIS SENSITIVITY SPECIFICITY
TP FP TN FN (95% CI) (95% CI)
Performance of Stage
0 (Males)
41 12 79 19 68.33 (55.1-79.7) 86.81 (78.1-93)
Performance of Stage
0 (Females)
41 12 132 16 71.93 (58.4-83.1) 91.67 (85.9-95.6)
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14. DISCUSSION
 Increased involvement of children and adolescents in
committing crimes
 Increased number of Asylum seekers
 Mincer et al., first to study the usefulness of 3rd molars to
discriminate juvenile versus adult status
 Cameriere et al., demonstrated better performance of I3M< 0.08
in discriminating adults or juveniles when compared to
Demirjian staging system
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15.  Acharya –first to use DS in India- one in four cases resulted
in “incorrect classification”
 Accuracy of three age estimation methods-
Cameriere's method was proved to be the best method, in
comparison to Willems and Acharya‘s methods.
 First study that compares 2 parameters Cameriere’s 3rd
molar maturity index and Pulp space visibility.
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16. Authors Population Sensitivity Specificity
Males Females Males Females
Galic et al. (2015) Croatia 84.3% 91.2% 95.4% 91.9%
Balla SB et al.
(2017)
South Indian 83.3% 90.2% 98.3% 95.1%
Our Study South Indian 68.33 86.81 71.93% 91.67%
Table 5: Various studies validating I3M
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17. Gender Cameriere's
Method
Pulp Visibility
Method
Males Sensitivity 76 68.33
Specificity 82 86.81
Females Sensitivity 77 71.93
Specificity 86 91.67
Table 6: Sensitivity and specificity of Cameriere's Method
and Pulp Visibility Method
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18. CONCLUSION
 Cameriere's cut off value (I3M < 0.08) is adequate to
discriminate juvenile/adult status in South Indian population
 Third molar maturity index by Cameriere's method can be a
reliable method of age estimation in South Indian population
when compared to the pulp space visibility
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19. References
 Sudheer B. Balla, Ivan Galic, Karunakar P, Stefano Vanin, Stefano De Luca,
Roberto Cameriere. Validation of third molar maturity index (I3M) for
discrimination of juvenile/adult status in South Indian population. Journal
of Forensic and Legal Medicine 2017;49:2-7.
 Andreas Olze, Tore Solheim, Ronald Schulz, Michael Kupfer, Andreas
Schmeling. Evaluation of the radiographic visibility of the root pulp in the
lower third molars for the purpose of forensic age estimation in living
individuals. Int J Legal Med 2010;124:183–186.
 Ivan Galic, Tomislav Lauc, Hrvoje Brkic, Marin Vodanovic, Elizabeta Galic,
Maria Gabriela Haye Biazevic et al. Cameriere’s third molar maturity index
in assessing age of majority. Forensic Science International 252 (2015)
191.e1–191.e5.
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20.  Mincer HH, Harris EF, Berryman HE. The A.B.F.O. study of third molar
development and its use as an estimator of chronological age. J Forensic
Sci. 1993 Mar;38(2):379e390.
 Cameriere R, Ferrante L, De Angelis D, Scarpino F, Galli F. The comparison
between measurement of open apices of third molars and Demirjian stages
to test chronological age of over 18 year olds in living subjects. Int J Leg
Med. 2008 Nov;122(6):493e497.
 Dardouri AA, Cameriere R, De Luca S, Vanin S. Third molar maturity index
by measurements of open apices in a Libyan sample of living subjects.
Forensic Sci Int. 2016 Oct;267, 230 e1- e6.
 Acharya AB. Age estimation in Indians using Demirjian's 8-teeth method. J
Forensic Sci. 2011 Jan;56(1):124e127.
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21. THANK YOU
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