Validity of the Demirjian method for dental age estimation in 4–17 years' Jordanian population: A cross-sectional study

Razan Jamil Salaymeh; Juman Mohammed Al-zaben; Dima Hamdi Bader

doi:10.4103/sidj.sidj_2_21

ORIGINAL ARTICLE

Year : 2021 | Volume : 5 | Issue : 2 | Page : 49-53

Validity of the Demirjian method for dental age estimation in 4–17 years' Jordanian population: A cross-sectional study

Razan Jamil Salaymeh¹, Juman Mohammed Al-zaben², Dima Hamdi Bader³
¹ Pediatric Dental Clinic, Department of Dental, Al-Bashir Hospital/Ministry of Health of Jordan, Amman, Jordan
² Orthodontic Clinic, Department of Dental, Al-Bashir Hospital/Ministry of Health of Jordan, Amman, Jordan
³ Oral Medicine Clinic, Department of Dental, Al-Bashir Hospital/ Ministry of Health of Jordan, Amman, Jordan

Date of Submission	27-Mar-2021
Date of Acceptance	28-Apr-2021
Date of Web Publication	29-Dec-2021

Correspondence Address:
Dr. Juman Mohammed Al-zaben
Al-Basheer Hospital, Ashrafeyah P.O. Box: 10005, Amman 11151
Jordan

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/sidj.sidj_2_21

Abstract

Introduction: The Demirjian's method has been advocated since 1973 as a universal method in dental age (DA) estimation. Several studies in different populations have shown that DA was overestimated compared with chronological age (CA).
The Objective of the Study: The aim of this study was to assess the DA in Jordanian children aged 4–17 years using the Demirjian method and compare it with the standard values provided by Demirjian.
Design of the Study: This was a cross-sectional study.
Subjects and Methods: Five hundred and eighty four panoramic radiographs of healthy children of both genders. The CA was scored from the medical record of the child and the dental age scored on all seven left mandibular teeth in the panoramic radiograph based on demirjian's method.
Statistical Testing: All data were collected, tabulated, and statistically analyzed using SPSS version 25. The statistical analyses were performed using an independent samples t-test and a correlation coefficient to analyze quantitative data and a scatter plot.
Results: The DA was overestimated than CA, especially in the intervals between 6–7, 14–15, and 16–17 years in females, and in the interval 12–13 and 16–17 years in males. Furthermore, there were significant correlations between CA and DA according to the girls in the intervals 9–14 years, and there were significant correlations between CA and DA related to boys in the intervals 6–7, 8–11, and 15–16 years. The results from this study have shown that Demirjian “s method cannot be applicable to be used to determine the estimated DA of the Jordanian population.
Conclusion: The Demirjian's method for dental estimation is not valid for the Jordanian population, and there should be another method for dental age estimation.

Keywords: Chronological age, Demirjian's method, dental age

How to cite this article:
Salaymeh RJ, Al-zaben JM, Bader DH. Validity of the Demirjian method for dental age estimation in 4–17 years' Jordanian population: A cross-sectional study. Saint Int Dent J 2021;5:49-53

How to cite this URL:
Salaymeh RJ, Al-zaben JM, Bader DH. Validity of the Demirjian method for dental age estimation in 4–17 years' Jordanian population: A cross-sectional study. Saint Int Dent J [serial online] 2021 [cited 2022 Jan 24];5:49-53. Available from: https://www.sidj.org/text.asp?2021/5/2/49/334156

Introduction

The Demirjian's method has been advocated since 1973 as a universal method in dental age (DA) estimation. This method is an important one in several disciplines such as forensic odontology, pediatrics, and orthodontics. The original Demerijian's sample consisted of panoramic radiographs of 1446 French-Canadian boys and 1482 French-Canadian girls ranging in age from 3 to 17 years.^[1] The revised version of the standards is based on data derived from a reference sample comprising 4756 French-Canadian children aged 2 ± 20 years.^[2]

Several studies have been published to assess the validity of Demirjian's method in different ethnic groups. Many of them showed that Demirjian's method overestimates the chronological age (CA) of their ethnic groups. A Belgian study in 2001 showed a mean difference between dental and CA of about 0.4 for males 0.7 for females.^[3] In addition, a Dutch study in 2005 showed that the DA is over ahead of CA, about 0.4 years for males and 0.6 years for females.^[4] In a western Chinese sample in 2010, the mean difference ranged from 0.0071 to 1.25 years in girls and from 1.00 to 1.30 years in boys,^[5] while an Egyptian study in 2019 showed a mean difference of about 0.466 years for males and 0.325 years for females.^[6]

On the other hand, other studies showed underestimating Demirjian's method compared to their population groups. In South Indians, the difference was 3.04 years in males and 2.82 years in females,^[7] and Saudis living in the city of Riyadh done in the year 2008 it was 0.3 years for males and 0.4 years for females),^[8] and in Kuwaitis, it was 2009; it was 0.71 years for males and 0.67 years for females,^[9] and in Tunisians, the difference ranged from 0.3 to 1.32 years for males and from 0.26 to 1.37 years for females.^[10]

Aim of the study

This cross-sectional study aims to assess the validity of Demirjian's method for estimation of the DA of children's Jordanian population and compare it with their CA.

Null hypothesis

The assessment of DA determined by Demirjian's for French-Canadian children may be suitable for the Jordanian children population.

Ethical regulation

Ethical approval was granted by the Ethics Committee of the Al-Basheer Hospital of the Ministry of Health of Jordan on 17/2/2018 and registered under 2811. The procedures followed were in accordance with the Declaration of Helsinki of 1975 as revised in 2000.

Subjects and Methods

The sample of this study consisted of 584 digital panoramic radiographs of Jordanian children ranging from 4 to 17 years old of both genders. They were taken from the database of the dental department – AL Basheer Hospital in Amman – Jordan. According to the Information and Research Directorate/Ministry of Health, patients are referred from eight primary health centers to the Dental Department of Al-Basheer Hospital. These centers contain a population of 439,664 served by 30 dentists. The exclusion criteria included:

Non-Jordanian ethnicity
Medically compromised
Unclear panoramic radiographs
Missing teeth.

CA was calculated from the child's date of birth and converted to decimal age. The DA was evaluated using Demirjian's method without the knowledge of the patient's CA. The method introduced by Demirjian et al. is based on scoring the developmental stage of the seven left permanent mandibular teeth. Eight stages of mineralization (A ± H) for each tooth are described. A biologically-weighted score is assigned to each stage for seven teeth, and the sum of the scores provides an estimate of the subject's dental maturity, measured on a scale of 0 to 100. The overall maturity score may then be converted to a DA using available tables and/or percentile curves. The standards are given for boys and girls separately.

Reproducibility

Twenty radiographs were selected and reassessed by the same examiner after 3 weeks. The intra-examiner reliability showed an excellent score with a kappa test score = 0.699.

Statistical testing

All data were collected, tabulated, and statistically analyzed using SPSS version 25. The statistical analyses were performed using an independent samples t-test and a correlation coefficient to analyze quantitative data and a scatter plot. Non-significant if ≥0.05; Significant if <0.05; Highly significant if <0.01; and Very highly significant if <0.001.

Results

Our study showed a statistically significant difference between means of chronological and DAs in both genders (females = −0.66, males = −0.88) [Table 1] and [Table 2].

Table 1: Compare means of chronological age with dental age according to females

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Table 2: Compare means of chronological age with dental age according to males

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Applicability of Demirjian's method

By reducing DA compared to CA, especially in the interval between 6-7, 14-15 and 16-17 years in women and 12-13 and 16-17 years in men [Table 3] and [Table 4] was estimated. Hence the null hypothesis was rejected.

Table 3: Compare means of chronological age with dental age according to females' age groups

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Table 4: Compare means of chronological age with dental age according to males age groups

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Correlation between the dental age and chronological age

The correlation coefficient of CA and DA was assessed in both genders. It showed a strong correlation between means of CA and DA. There were significant correlations between CA and DA according to the girls in the intervals 9–14 years, and there were significant correlations between CA and DA related to boys in the intervals 6–7, 8–11, and 15–16 years.

This correlation was performed using a scatter plot graph and confirmed by the Pearson correlation coefficient (0.827 in females, 0.845 in males) [Table 5], [Table 6], [Table 7], [Table 8] and [Graph 1], [Graph 2].

Table 5: Pearson correlation coefficient of chronological age and dental age according to females' age groups

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Table 6: Pearson correlation coefficient of chronological age and dental age according to males' age groups

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Table 7: Pearson correlation coefficient of chronological age and dental age according to the females' age groups

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Table 8: Pearson correlation coefficient of chronological age and dental age according to males' age groups

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Discussion

Determination of CA is simple to calculate but not an accurate indicator of growth. DA assessment using a Demirjian's method has good reproducibility and reliability, but its applicability and universal acceptance remain between geographical areas. This study showed that Jordanian children had a more advanced DA when compared to French-Canadian children from Demirjian's study. This means that Demirjian's method does not accurately estimate the DA of our sample. There was an overestimation of DA. Our results are similar with the Malaysian study to a greater extent (0.75 for males and by 0.61 years for females)^[11] and to a lesser extent in other studies (Willems G et al. 2001, 0.4 for males and 0.7 for females, Leurs I et al. 2005, 0.4 for males and 0.6 for females, and Moones AM et al. 2019, 0.466 years for males and 0.325 years for females), but it was different to other studies where underestimation was reported (AL-Emran et al. 2008, 0.3 years for males and 0.4 years for females, Queidmat et al. 2009, 0.71 years for males and 0.67 years for females, and Aissouie et al. 2016, 0.3–1.32 years for males and from 0.26 to 1.37 years for females).

This difference in over-or underestimation between different population groups may be attributed to ethnic differences (Koshy et al.),^[7] a positive secular trend over the last 50 years, and/or other factors such as diet and nutrition.^[12]

The results of the current study revealed that there were significant correlations between CA and DA according to the girls in the intervals 9–14 years, and there were significant correlations between CA and DA related to boys in the interval 6–7, 8–11, and 15–16 years. There was advanced dental maturation in specific age groups of both genders. This may be explained that skeletal and sexual maturation correlate with DA in these age groups, which was confirmed by many studies.^{[13],[14],[15],[16]} However, many studies reported a weak correlation between DA and skeletal maturity.^{[17],[18],[19]} Still, there is no good evidence that DA can be a reliable indicator for skeletal growth, but it can give a rough estimate for skeletal maturity.^[20],[21]

Conclusion

The results of this study have shown that Demirjian “s method has some limitations when used to determine the estimated DA of the Jordanian population, and there should be another method for estimating or doing a predictive equation of Demirijian's DA estimation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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