Age Estimation in Senegalese from Pulp/Tooth Area Ratio of Mandibular Premolars and Molars
Corresponding Author: Sankoung Soumboundou, Department of Legal Dentistry, University Cheikh Anta Diop, Fann, Dakar, Senegal, Phone: +221776590371, e-mail: email@example.com
Introduction: Age determination is essential for human being, because of its social, legal, and judicial involvement. The tooth represents an excellent medicolegal tool for age assessment through its growth, biological behavior, and aging. The aim of this study was to find a correlation between pulp volume dimension and chronological age (AC) using the Drusini’s method.
Materials and methods: A total of 150 panoramic radiographs of Senegalese people aged 10–44 years were included in this study. Drusini’s method was used to estimate age. The collected data were analyzed with R software version 3.6.1. Student’s t-test was used for mean comparisons with a significance threshold of 0.01.
Results: The average premolar height of the coronal pulp cavity (CPCH) value was 2.64 mm in men and 2.28 mm in women. The mean molar toothcoronal index—molar (TCI-M1) value was 41.59–4.04 in women and 38.78 (4.87) in men. The result of the Pearson’s correlation test shows a negative correlation of –0.899, significant between molar TCI and AC (p < 0.001). A strong correlation was also noted between AC and premolar TCI (p < 0.001).
Conclusion: Drusini et al.’s method could be a useful tool for age determination in a Senegalese population.
How to cite this article: Soumboundou S, Ndiaye ML, Lecor PA, et al. Age Estimation in Senegalese from Pulp/Tooth Area Ratio of Mandibular Premolars and Molars. CODS J Dent 2021;13(2):51-54.
Source of support: Nil
Conflict of interest: None
Keywords: Age estimation, Coronal pulp index, Drusini’s method, Forensic dentistry
The discovery of a nonidentified body raises questions to be answered by the coroner, among them, the age of the dead body. Research is then undertaken to determine the profile (ethnicity, sex, and age) of the victim. In age assessment, bone and dental methods are most widely used. The role of the dental organ in this estimation process is often decisive. Because of its biological behavior and morphological features, the tooth represents a medicolegal tool of extreme importance in the assessment of age.1 This last one is based on the study of the root transparency, the racemization of the amino acids, the radiological and genetic methods. The study of pulp aging as an indicator of age is based on knowledge of the repairing potential of the pulp, whose production of physiological secondary restorative dentin continues in adult teeth.
In 1925, Bodecker showed that AC was correlated with the affixing of secondary dentin.2 Ikeda et al., in 1985, developed the coronal pulp index (TCI) for age estimation by taking X-rays of extracted teeth.3
Later, Drusini, in 1993, applied the calculation of TCI on radiographs of living people.4 According to Drusini et al., this affixing of secondary dentin remains a morphological indicator and a significant biomarker of dental age, as it is not an alteration caused by dental erosion.5
To date, no studies have tested its applicability in West African melanoderm subjects. This study was aimed to test the validity of the coronal pulp index on a sample of Senegalese melanoderm people.
MATERIALS AND METHODS
This descriptive study was carried out within the Department of Odontology of the Faculty of Medicine, Pharmacy, and Odontology of Dakar (Senegal).
In the present study, teeth with restorations, caries, pathologies (including periapical lesions), and severe attrition were excluded. Furthermore, endodontically treated teeth, or teeth with orthodontic appliances that resulted in inadequate visualization and inability to acquire measurements, were not included in the study. Poor quality Orthopantomograms (OPGs) with inadequate exposure, incorrect patient positioning, and unsharp images were omitted. Thus, the number of teeth analyzed in each OPG varied based on the clinical and radiological characteristics.
The sample size was determined from the results obtained by Ngom et al.9
The statistical formula below was used to estimate the study population (95% confidence level and 0.06 degree of accuracy).
The parameters height of the crown (CH) and CPCH were studied. Then TCI for each tooth was calculated as follows:
TCI = CPCH × 100/CH (Fig. 1).
CH: is the maximum perpendicular distance from the cervical line to the tip of the highest cusp of tooth.
CPCH: is the distance from cervical line to the coronal tip of the pulp chamber.
All JPEG panoramic radiographs have been converted to DICOM and processed with the Radiant 3D software (Fig. 2). The measurements made for the CH and CPCH distances were recorded in millimeters (mm).
Statistical analysis was performed using the R package, version 3.6.1. First, for quantitative data, Student’s t-test was used to compare between two groups (males and females).
Secondly, the Spearson’s test was used to determine the correlation between chronological and TCI (molar and premolar) was obtained by linear regression analysis. In all tests, p < 0.05 was considered statistically significant. Finally, different regression models were explored in the calculations of dental age (taken as dependent variable) as a function of the TCI score.
A total of 150 panoramic radiographs were analyzed. The average AC was 18.0 ± 7.04 years for women and 17.1 ± 5.84 years for men. Table 1 shows the averages of the CH and CPCH measurements at the level of the first premolar and first mandibular molar. The premolar CH was slightly higher in men 6.85 ± 0.85 mm than in women 5.60 ± 0.92 mm. No statistically significant differences by sex were noted.
Table 2 shows the averages of CH and CPCH measurements at the first mandibular molar. The mean CH value was 6.05–1.03 mm in women and 6.42–1.84 mm in women. The mean CPCH value was 2.38–0.49 mm in women and 2.59–0.75 in men.
Table 3 shows the average of molar and premolar inner crown teeth (ICT) in men and women. The mean TCI-M1 was 41.59–4.04 in women and 38.78–4.87 in men.
|TCI-PM1||42.33 ± 3.98||40.59 ± 4.89||0.269|
The Student’s t-test result shows no statistically significant difference (Table 4).
The linear regression between the AC and TCI—premolar (PM1) showed a strongly significant negative correlation p < 0.001 (Fig. 3).
The linear regression between AC and TCI-M1 showed a strongly significant correlation p < 0.001 (Fig. 4).
Reduction in pulp cavity volume due to secondary dentin deposition could be used as an indicator of age.10 This morphological change can be observed and analyzed by three-dimensional and two-dimensional panoramic radiological techniques.
The method consisted of evaluating the dimensions of the pulp chamber (CPCH) and the crown (CH) using the Radiant 3D software.
The mean value obtained for CH-M1 was 6.05 mm for women and 6.42 mm for men. For CPCH-M1, the average value was 2.38 mm for women and 2.59 mm for men. At the level of CH-PM1, the average was 5.60 mm in women and 6.85 mm in men. The mean CPCH-PM1 value was 2.64 mm in men and 2.28 mm in women. The result of the Student’s t-test showed no statistically significant difference (p < 0.001). The mean TCI-M1 value was 38.78 ± 4.87 mm for men and 41.59 ± 4.04 mm for women. The mean TCI-PM1 value was 40.59 ± 4.89 mm for men and 42.33 ± 3.98 mm for women.
The result of the Pearson’s correlation test shows a strongly significant negative correlation between molar TCI and AC p < 0.001.
The mean dental age determined from the Drusini et al.5 prediction equation was 17.1 in men and 18.0 in women. The correlation coefficient between TCI-PM1 and AC was –0.800 and TCI-M1 –0.899. The linear regression calculated between TCI and AC was AC = 75.77 – 1.45 × TCI (M1) and AC = 77.31 – 1.46 × TCI (PM1).
The results of this study are similar to those of the Koranne et al.11 study in Indian subjects aged 20–60 years.
The authors concluded that the Drusini’s method is simple, noninvasive, inexpensive, and of good applicability.11
Similarly, Igbigbi and Nyirenda12 in their study of the estimated age of 134 adults, including 77 men and 57 women aged 20–80 years, concluded that the Drusini’s method was valid. The results of their study show a strong correlation in both men (r = –0.650) and women (–0.799) between AC and molar and premolar TCI.12
In Australia, Karkhanis et al. in a large sample, 220 women and 230 men indicated that the method may be applicable for forensic purposes.13 Results of Talabani et al.14 from 96 participants corroborated the results of this study and those of Karkhanis et al.13 and Koranne et al.11
The study by Havale et al.15 with 100 children aged 5–10 years, confirms the results of this study. With a correlation coefficient r = –0.59, found between AC and TCI, the authors had concluded that the Drusini’s method is well applicable.16 Drusini, out of a sample of 433 participants, had a strong correlation of –0.92 AC and TCI.16 With an error of ±5 years in 81.4% of cases at the level of molar TCI in men, Drusini16 has estimated that this method, based on pulp aging, can be easily applied in the determination of the age of living and deceased individuals.
The congruence of the Drusini’s method is also highlighted by Gotmare et al.’s17 study of 88 people (54 men and 34 women). The results concluded that TCI is a reliable, accurate, noninvasive, and easy-to-use biomarker for age estimation and may be applicable to living and deceased individuals.17,18 The results of this study are different from those of Jain et al.18 involving 180 subjects of Chhattisgarh aged 15–70 years. Jain et al.18 found a weak correlation with TCI-M1 r = –0.178 and TCI-PM1 r = –0.187. The authors concluded that the method was not valid.18
Gok et al.19 also concluded that the Drusini’s method was not applicable in a sample of 9,059 Turkish people aged 15–40 years. Another Pakistani study by Badar et al., on 80 participants concluded that TCI could not be used for age estimation.20
In short, the method used in this study is simple and inexpensive. The results obtained have showed good congruence and applicability. However, further studies with a larger sample are needed.
The Drusini’s method used in this study is simple and noninvasive. The results obtained show a highly acceptable congruence for estimating age. Therefore, it can be recommended in forensic medicine for age estimation especially in a Senegalese context marked by the problem of “ghost pupils”.
1. De Salvia A, Calzetta C, Orrico M, et al. Third mandibular molar radiological development as an indicator of chronological age in a European population. Forensic Sci Int 2004;146 Suppl:S9–S12. DOI: 10.1016/j.forsciint.2004.09.021
2. Bodecker CF. A consideration of some of the changes in the teeth from young to old age. Dental Cosmos 1925;67:543–549.
3. Ikeda N, Umetsu K, Kashimura S, et al. Estimation of age from teeth with their soft X-ray findings. Nihon Hoigaku Zasshi 1985;39(3):244–250.
5. Drusini AG, Toso O, Ranzato C. The coronal pulp cavity index: a biomarker for age determination in human adults. Am J Phys Anthropol 1997;103(3):353–363. DOI: 10.1002/(SICI)1096-8644(199707)103:3%3C353::AID-AJPA5%3E3.0.CO;2-R
8. Shrestha M, Srikant N, Nepal R, et al. Comparative evaluation of two established age estimation techniques (two histological and radiological) by Image Analysis Software using single tooth. Open Forensic Sci J 2015;20(8):1–7. DOI: 10.2174/1874402801508010001
13. Karkhanis S, Mack P, Franklin D. Age estimation standards for a Western Australian population using the coronal pulp cavity index. Forensic Sci Int 2013;231(1–3):412.e1–412.e6. DOI: 10.1016/j.forsciint.2013.04.004
14. Talabani RM, Baban MT, Mahmood MA. Age estimation using lower permanent first molars on a panoramic radiograph: a digital image analysis. J Forensic Dent Sci 2015;7(2):158–162. DOI: 10.4103/0975-1475.154597
18. Jain S, Nagi R, Daga M, et al. Tooth coronal index and pulp/tooth ratio in dental age estimation on digital panoramic radiographs—a comparative study. Forensic Sci Int 2017;277:115–121. DOI: 10.1016/j.forsciint.2017.05.006
19. Gok E, Fedakar R, Kafa IM. Correction to: Usability of dental pulp visibility and tooth coronal index in digital panoramic radiography in age estimation in the forensic medicine. Int J Legal Med 2020;134(3):1265. DOI: 10.1007/s00414-019-02218-7
20. Badar SB, Ghafoor R, Khan FR, et al. Age estimation of a sample of Pakistani population using coronal pulp cavity index in molars and premolars on orthopantomogram. J Pak Med Assoc 2016;66(Suppl 3)(10):S39–S41. PMID: 27895350.
© The Author(s). 2021 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.