Is chronological age predictable on panoramic images using the Demirjian method on third molars? Insights from a Turkish population-based study

TL;DR

This study shows that the modified Demirjian method can accurately estimate age in Turkish adolescents using third molar development stages from panoramic X-rays.

Contribution

The study validates the modified Demirjian method for age estimation in a Turkish population and identifies interaction effects between gender, impaction, and tooth development.

Findings

Third molar development stages strongly correlate with chronological age in Turkish adolescents.

Generalized linear models confirmed age as a significant predictor of tooth development stages.

Interactions between gender and impaction classifications influence developmental patterns.

Abstract

Third molars are crucial in forensic age estimation during adolescence due to their late and variable development. The modified Demirjian method employs a nine-stage classification (0-H) for assessing dental maturity. However, population-specific validation is essential for forensic accuracy. This study aims to evaluate the relationship between chronological age and M3 development stages in a Turkish population using panoramic radiographs, and to investigate the influence of gender and anatomical location, including impaction classifications (Pell-Gregory and Winter).

A total of 1656 individuals (mean age: 13.9±3.78 years) underwent digital panoramic radiography. Developmental stages of 2770 mandibular and 2553 maxillary M3s were assessed using the modified Demirjian method. Statistical analyses included Spearman correlation, Kruskal-Wallis tests and generalized linear models.

Third molar development strongly correlated with chronological age. Most teeth were in stages B-E, with mandibular M3s most frequent in stages C and E, and maxillary in C and D. Age differed significantly across all stages (p<0.001). Generalized linear models confirmed age as a significant predictor (R²=0.330 mandible; R²=0.337 maxilla). Gender and impaction classifications had no main effects, but significant interactions were found (Pell-Gregory×Gender: p<0.001; Winter×Pell-Gregory: p=0.016).

The modified Demirjian method reliably estimates age in Turkish adolescents, with high age-stage correlation. While gender and anatomical location alone do not alter developmental progression, their interaction with impaction patterns reveals complex growth dynamics. These findings support context-sensitive forensic protocols.

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