Dental Age Estimation based on Development Dental Atlas Assessment in a Child/Adolescent Population with Systemic Diseases

Forensic estimation of chronological age has played an increasingly important role as part of cadaver identification, and also in living individuals due to the phenomenon of immigration and sexual abuse of undocumented trafficked children. This research aimed to validate the already used dental mineralization and eruption atlas in normal children and adolescent population in estimating chronological age in a young population, particularly those with special needs, majority of them with systemic diseases. A sample of 163 orthopantomograms from two independent medical institutions was collected from 133 patients aged between 4 and 23 years. The orthopantomograms were divided into two groups, 95 from patients with systemic pathologies that have repercussions on dental development and 68 with systemic pathologies without dental repercussions. Dental ages were estimated by the London Atlas using the left side and then independently the right side of the maxilla. The intraobserver and interobserver agreements were evaluated. The difference between dental age estimates and the chronological age and its absolute value were calculated and analyzed. Statistically significant differences were found between estimates and chronological age, revealing a general prevalence for underestimation; except for those under the age of 12. Nevertheless, the underestimation in individuals under the age of 16 was not significant (with an average of less than one month), while the underestimation was significant for persons who were at least 16 years old (with an average over 26 months). Furthermore, for those persons with systemic diseases with dental repercussions a greater error in underestimation was obtained, which indicates that the midpoint values should be reassessed in persons with Down's syndrome, chromosomal alterations, syndromes and central nervous system disorders. This atlas can be potentially used as a tool for age estimation in a population with special needs and, also, in a population with systemic diseases, but we suggest further studies with larger international samples to create adequate atlases for all the required scenarios, mainly, diagrams for people with systemic diseases who are over the age of 16.