Advances in Human Biology

ORIGINAL ARTICLE
Year
: 2016  |  Volume : 6  |  Issue : 3  |  Page : 119--128

A Comparative Analysis between Width and Length Variables in Kvaal's and Cameriere's Methods of Age Estimation in a Specific Populace of Andhra Pradesh


Mohammed Arif Dar1, A Ravikiran2, Abhishek Singh Nayyar3, Anand B Babu4,  
1 Department of Oral Medicine and Radiology, Government Dental College and Hospital, Srinagar, Jammu and Kashmir, India
2 Department of Oral Medicine and Radiology, Sibar Institute of Dental Sciences, Guntur, India
3 Department of Oral Medicine and Radiology, Saraswati Dhanwantari Dental College and Hospital and Post-Graduate Research Institute, Parbhani, Maharashtra, India
4 Department of Oral Medicine and Radiology, Lenora Institute of Dental Sciences, Rajahmundry, Andhra Pradesh, India

Correspondence Address:
Abhishek Singh Nayyar
44, Behind Singla Nursing Home, New Friends Colony, Model Town, Panipat - 132 103, Haryana
India

Abstract

Context: Comparison between ante- and post-mortem dental records and radiographs produces results with a high degree of reliability and relative simplicity. Kvaal et al. introduced an age estimation method by indirectly measuring secondary dentin deposition on radiographs. Cameriere et al., later, put forth a method based on radiographic estimation of pulp/tooth area ratio (AR) in canines. The purpose of the present study was to assess the validity and reliability of the various width and length variables in Kvaal俟Q製 and Cameriere俟Q製 methods of age estimation in a specific populace of Andhra Pradesh origin. Materials and Methods: One hundred and ten patients aged between 15 and 75 years were selected, and the variables p = complete pulp length/root length (from enamel-cementum junction [ECJ]-root apex), r = complete pulp length/complete tooth length, a = complete pulp length/root width at ECJ level, b = pulp/root width at midpoint level between ECJ level and mid-root level and c = pulp/root width at mid-root level and pulp/tooth AR were recorded as devised in Kvaal俟Q製 and Cameriere俟Q製 methods of age estimation, respectively. Statistical Analysis: Statistical analysis was performed with SPSS software (version 10.5) package. Mean comparison of morphological variables was carried out using Student俟Q製 t-test. Intra- and inter-observer reproducibility of measurements was studied using the concordance correlation coefficient. Results: Of all the morphological variables, variables such as p = complete pulp length/root length (from ECJ-root apex), r = complete pulp length/complete tooth length and mean (M), length (L) and pulp/tooth AR correlated significantly, with age with variable p = complete pulp length/root length (from ECJ-root apex) correlating the best amongst them. Conclusion: Variables associated with width ratios (a = complete pulp length/root width at ECJ level, b = pulp/root width at midpoint level between ECJ level and mid-root level and c = pulp/root width at mid-root level) rather than length ratios (p = complete pulp length/root length [from ECJ-root apex] and r = complete pulp length/complete tooth length) correlated best with chronological age in the populace of Andhra Pradesh origin.



How to cite this article:
Dar MA, Ravikiran A, Nayyar AS, Babu AB. A Comparative Analysis between Width and Length Variables in Kvaal's and Cameriere's Methods of Age Estimation in a Specific Populace of Andhra Pradesh.Adv Hum Biol 2016;6:119-128


How to cite this URL:
Dar MA, Ravikiran A, Nayyar AS, Babu AB. A Comparative Analysis between Width and Length Variables in Kvaal's and Cameriere's Methods of Age Estimation in a Specific Populace of Andhra Pradesh. Adv Hum Biol [serial online] 2016 [cited 2020 May 31 ];6:119-128
Available from: http://www.aihbonline.com/text.asp?2016/6/3/119/195317


Full Text

 Introduction



Aging refers to irreversible and inevitable changes that occur with time, which encompass all aspects of human life, namely, anatomic, physiologic and psychological. [1] Aging, in forensic context, is necessary both for the dead and the living. For the dead, it is principal to aid identification by creating a biological profile which can, then, be compared to missing individuals. For the living, the aim is to solve judicial or civil problems concerning the age of minors as regards questions of adoption, immutability, and for adults, civil issues, for individuals lacking valid identification documents. [2] Although several parts of the body can be used for age estimation, the poor condition of the remains, particularly, in severe crashes or, fires in cases of those recently dead, or, of moisture and burial conditions in cases of historic subjects, make many parts of the body unusable. [3] Despite these problems, in the past few years, literature has provided several skeletal and dental methods for assessing age. Most of them apply many age indicators related to degenerative changes in the skeleton. [4] Teeth can survive, in most of the conditions, encountered at death and during decomposition, even when the body is exposed to extreme forces and/or temperatures. [5] The specific composition and shape of teeth are a source for many different hereditary and acquired characteristics. Thus, they can serve as reliable biomarkers of aging. It is also observed that tooth development is not perceptibly affected by diseases, drugs as well as the endocrine status as compared to the bones, consequently making them the preferred tissue in forensic and archaeological investigations. [5] Once a tooth is fully mineralised and erupted, it forms a very stable entity. Both the developmental and regressive changes affecting the teeth can be related to chronological age of the individual. In the past few years, forensic odontology has shown increasing interest in search for optimal age estimation methods in individuals using dental tissues/teeth as evidence. These methods are broadly classified as: Morphologic and radiologic methods. The former are further subclassified as clinical, histologic and biochemical methods which include methods analysing the various forms of tooth modification such as wear, dentin transparency, tooth cementum annulations, racemisation of aspartic acid and apposition of secondary dentin. [3] However, all these methods have one or the other limitations restricting their usage on a mass scale. In addition, radiography, being a non-destructive method, plays a vital role in forensic odontology to uncover the hidden facts, which cannot be seen by means of physical examination. Dental examination and comparison between ante- and post-mortem dental records and radiographs produce results with a high degree of reliability and relative simplicity. [6],[7] Radiographic age estimation, using teeth, rely on developmental stages of teeth, especially in children, while in adults, continuous deposition of secondary dentin throughout the life depicted by reduction in pulp area can be employed. Several age estimation methods exploit changes undergone by teeth during the lifetime but most are destructive warranting extraction of teeth. These methods, therefore, cannot be used in living individuals and in cases, where it is not acceptable to extract teeth for various reasons. [8] Radiography, thus, plays an important role in such cases. [9] Dental pulp is a mesenchymal tissue surrounded by a pulp canal. Outside the pulp, there are some odontoblastic lines, which release dentin during the subject's life and reduce the size of the pulp canal. Changes in its size caused by the apposition of secondary dentin are the best morphometric parameters for estimating age in adults as it is a continuous process that takes place throughout the life of an individual. This apposition of secondary dentin can be indirectly measured by the reduction in pulp size on the radiographs. In 1925, Bodecker established that the apposition of secondary dentin correlated with age. [10] Kvaal et al. introduced an age estimation method by indirectly measuring secondary dentin deposition on radiographs and proposed a number of length and width measurements of tooth and pulp. [6] Cameriere et al., later, put forth a similar method based on radiographic estimation of pulp/tooth area ratio (AR) in canines. [7] The purpose of the present study was to assess the validity and reliability of the various width and length variables in Kvaal's and Cameriere's methods of age estimation in a specific populace of Andhra Pradesh origin.

 Materials and Methods



Source of data

A total number of 110 patients, 59 males and 51 females, aged between 15 and 75 years, were selected from the outpatient department. Seven age groups (Group I-VII) were formed with both male and female patients. Group I consisted of 15 patients with age between 15 and 20 years, Group II (age 20-30 years) with 47 patients, Group III (age 30-40 years) with 23 patients, Group IV (age 40-50 years) with 15 patients, Group V (age 50-60 years) with three patients, Group VI (age 60-70 years) with four patients and Group VII (age 70-75 years) with three patients. The permission to conduct the present study was obtained from the Institutional Ethics Committee. All the patients gave informed consent before being included in the study.

Selection criteria

Inclusion criteria

Patients aged between 15 and 75 yearsThe selected teeth were the right or left maxillary central incisor, lateral incisor and 2 nd premolar and right or left mandibular lateral incisor, canine and 1 st premolar which had fully erupted into the oral cavityThe roots of the teeth were fully formedIndividuals were of ethnic origin from Andhra Pradesh (history confirmed up to two generations).

Exclusion criteria

Teeth with any pathology such as caries or periodontitis or periapical lesions that would alter the surface area of the toothTeeth with any prosthetic rehabilitation and orthodontic applianceFractured teethSeverely attrited teeth secondary to parafunctional habitsTeeth with any developmental anomaly.

After clinical examination, patients who fitted into the inclusion criteria were subjected to digital intraoral radiographs.

Methodology

Intraoral radiography

Patients were selected according to the decided inclusion criteria. After selection of the patients, their consent was taken for radiographic examination. All the guidelines were followed as per the ALARA principle while subjecting the patients to digital intraoral radiographs. The radiographic examination was carried out with the help of X mind X-ray system, 70 kv, 8 mA, 0.425 kVA, 2 mm aluminium filter manufactured by SATELEC (India) Private Limited; DIGORA OPTIME DXR-50 5001, Digital Imaging System with Windows 2.8 Digital Imaging Programme. PSP Digital Sensor (DIGORA OPTIME DXR-50 5001, Digital Imaging System) with Size 2 sensor (31 × 41) mm and Film-holding instrument: RINN-Greene Stabe Disposable Film Holder were used with Auto-CAD 2007 software (Autodesk Inc., San Rafael, CA, USA) for taking digital intraoral radiographs.

Positioning of the patient

For maxillary teeth: The patient's head was positioned upright with the sagittal plane vertical and the occlusal plane horizontal.

For mandibular teeth: The patient's head was tilted back slightly to compensate for the change in occlusal plane when the mouth was opened.

Measurement of teeth by Kvaal's method [Figure 1]: The following morphological variables were recorded by Kvaal's method:

p = complete pulp length/root length (from enamel-cementum junction [ECJ]-root apex)

r = complete pulp length/complete tooth length

a = complete pulp length/root width at ECJ level

b = pulp/root width at midpoint level between ECJ level and midroot level

c = pulp/root width at midroot level.{Figure 1}

Measurement of teeth by Cameriere's method

Pulp/tooth AR was recorded. Measurements were made by a second observer to prevent any interobserver bias. The morphological variables, chronological age and patients' gender were entered in a Microsoft EXCEL spreadsheet for use as predictive variables for age estimation. Correlation coefficients were evaluated between chronological age and morphological variables. Estimated age was obtained using morphological variables for each tooth [Figure 2].{Figure 2}

Statistical analysis

Statistical analysis was performed with SPSS software (version 10.5, SPSS Inc., 233 South Wackier Drive, 11 th Floor, Chicago, USA) package. Mean comparison of morphological variables was carried out using Student's t-test. Intra- and inter-observer reproducibility of measurements was studied using the concordance correlation coefficient.

 Results



The chronological age of adults was estimated based on the measurements of the different said variables of the various teeth including maxillary central incisor, lateral incisor and 2 nd premolar and mandibular lateral incisor, canine and 1 st premolar, which were numbered 1-6, respectively, on images of digital intraoral radiographs from the derived regression equations. The demographic data of the patients are shown in [Table 1] and [Graph 1 [SUPPORTING:1]]. There was no significant difference observed between morphological variables amongst the males and females, indicating gender did not influence the estimation of chronological age [Table 2],[Table 2],[Table 3],[Table 4],[Table 5] and [Table 6]. In tooth #4 (mandibular lateral incisor), however, morphological variables such as b = pulp/root width at midpoint level between ECJ level and midroot level and width (W) showed a weakly positive correlation between gender and chronological age [Table 7]. Comparison of the readings of the two observers did not reveal any statistical significance [Table 8]. Karl Pearson's correlation coefficients between age and morphological variables showed that the variables p = complete pulp length/root length (from ECJ-root apex), r = complete pulp length/complete tooth length, mean (M), length (L) and pulp/tooth AR correlated significantly with age with variable p = complete pulp length/root length (from ECJ-root apex) correlating the best amongst them. The ratios between width measurements (a = complete pulp length/root width at ECJ level, b = pulp/root width at midpoint level between ECJ level and midroot level and c = pulp/root width at midroot level) correlated least with age and were not found to be statistically significant and therefore were excluded from further statistical analysis. Variable p = complete pulp length/root length (from ECJ-root apex) had the highest value of p − 0.920 for central incisor and − 0.951 for mandibular 1 st premolar [Table 9]. The scatter plot graph between predicted age and chronological age showed that the resultant values were equally distributed along the line. Comparing between Kvaal's and Cameriere's methods, results of the latter method were found to be more accurate in predicting age. The scatter plot graph between predicted versus chronological age showed better distribution in Cameriere's method than Kvaal's method [[Graph 2 [SUPPORTING:2]],[Graph 3 [SUPPORTING:3]] and [Graph 4 [SUPPORTING:4]]; with Graph 2 showing comparative analysis between Kvaal's and Cameriere's methods; Graph 3 for Kvaal's method and Graph 4 for Cameriere's method]. Separate regression equations were derived for each tooth for both the methods. The variables such as mean (M) (mean of variables complete pulp length/root length [from ECJ-root apex] [p], complete pulp length/complete tooth length [r], complete pulp length/root width at ECJ level [a], pulp/root width at midpoint level between ECJ level and midroot level [b] and pulp/root width at midroot level [c]) and difference between width and length (W − L) contributed significantly and were utilised in regression equation for Kvaal's method [Table 10]. Variable pulp/tooth AR contributed significantly and was utilised in regression equation for Cameriere's method [Table 11]. In Kvaal's method, tooth #6 (mandibular 1 st premolar) correlated best with age with an R2 value of 81.90% and a standard error of the estimate in years (S.E.E.) of 5.889 years followed by tooth #1 (maxillary central incisor) (R2 = 80.30%), tooth #2 (maxillary lateral incisor) (R2 = 70.70%), tooth #4 (mandibular lateral incisor) (R2 = 61.90), tooth #5 (mandibular canine) (R2 = 47.90%) and tooth #3 (maxillary 2 nd premolar) (R2 = 31.50%) [Table 10]. In Cameriere's method, tooth #6 (mandibular 1 st premolar) correlated best with age with an R2 value of 93.50% and an S.E.E. of 3.564 years followed by tooth #1 (maxillary central incisor) (R2 = 87.90%), tooth #4 (mandibular lateral incisor) (R2 = 86.30%), tooth #2 (maxillary lateral incisor) (R2 = 85.50%), tooth #5 (mandibular canine) (R2 = 85.40%) and tooth #3 (maxillary 2 nd premolar) (R2 = 83.30%) [Table 11].{Table 1}{Table 2}{Table 3}{Table 4}{Table 5}{Table 6}{Table 7}{Table 8}{Table 9}{Table 10}{Table 11}

 Discussion



In 1995, Kvaal et al. [6] presented a method for age estimation which was based on investigation of periapical radiographs while Paewinsky et al. [11] verified the applicability of this method on orthopantomographs. Cameriere et al., in 2004, for the first time conducted a preliminary study to evaluate the variations in pulp/tooth AR as an indicator of age, and their method of age estimation seemed promising. [7] While the authors obtained high levels of accuracy in age prediction, they advised that future research should investigate 'the effect of race and culture in model parameters'. Indeed, other researchers have also advocated the verification of age estimation methods on independent samples and some have concluded that best results are derived when population-specific formulas are used. Babshet et al. found that Cameriere's formula, based on the Italian population, is not as applicable to the Indian population as was the case of naive population. [12] The purpose of the present study was to compare the reliability of various teeth in Kvaal's and Cameriere's methods of age estimation in a specific populace of Andhra Pradesh origin based on the relationship between chronological age and measurement of different variables, as used in Kvaal's and Cameriere's methods, of selected teeth, using digital intraoral periapical radiographs. The study sample included 110 patients aged between 15 and 75 years, only of Andhra Pradesh origin with at least last two generations residing in the location of the study. This was done to ensure ethnic uniformity of the study sample, considering that the development of teeth varies among populations and that it is genetically determined. Digital radiography was selected because of less radiation exposure than the conventional film-based radiography. Since Kvaal et al. did not find significant differences between teeth from the left and the right sides of the jaw, [6] teeth from either the left or right side were processed depending on whichever were best suited for measurements. Ratios between the teeth and pulp size were calculated. This procedure helped to reduce the effect of the possible variation in magnification and angulation of the intraoral radiographs. The present study revealed that gender had no significant influence on the morphological variables of teeth, except for morphological variables i.e. b = pulp/root width at midpoint level between ECJ level and midroot level and width (W), which showed a weak positive correlation between gender and chronological age for mandibular lateral incisor, similar to the findings of the studies conducted by Kvaal et al. [6] and Cameriere et al. [7] Few other studies by Jeevan et al. [13] and Cameriere et al. [14],[15] also showed similar results. In the present study, width ratios (a = complete pulp length/root width at enamel-cementum junction (ECJ) level, b = pulp/root width at midpoint level between ECJ level and mid-root level and c = pulp/root width at mid-root level) did not show significant correlation with age. In addition, there were no significant differences between inter- and intra-observer measurements in the present study, similar to the studies conducted by Kvaal et al., [6] Cameriere et al., [7],[14],[15] Paewinsky et al., [11] Jeevan et al. [13] and Zaheer et al. [16] In the present study, Pearson's correlation coefficients between chronological age and morphological variables showed that the variables p = complete pulp length/root length (from ECJ-root apex), r = complete pulp length/complete tooth length, length (L) and pulp/tooth AR correlated well with the chronological age. Using Cameriere's method, it was found that the morphological variable pulp/tooth AR contributed significantly to the chronological age estimation in contrast to the findings of the study conducted by Saxena. [3] Similarly, contrasting results were found with the studies conducted by Kvaal et al. [6] and Bosmans et al. [17] which showed better correlation of chronological age with morphological variables associated with width ratios (a = complete pulp length/root width at ECJ level, b = pulp/root width at midpoint level between ECJ level and midroot level and c = pulp/root width at midroot level) rather than length ratios (p = complete pulp length/root length [from ECJ-root apex] and r = complete pulp length/complete tooth length). The results of the present study were in slight disagreement with the findings of the studies conducted by Meinl et al. [9] and Kanchan-Talreja et al., [18] with the variations observed explained on the basis of the diversity in the ethnicity of the population under study. In the present study, mandibular 1 st premolar correlated best with age for Kvaal's method with an R2 value of 81.90% and an S.E.E. of 5.889 which was in contrast with the study conducted by Kvaal et al., [6] in which maxillary central incisor correlated best with age with an R2 value of 70.00% and an S.E.E. of 9.5 years. The differences in the findings of the present study as against the other studies might be explained on the basis of the regional, cultural and ethnic variations seen in the populations studied. This is the reason as to why population-specific regression equations are supposed to be kept in mind while arriving at specific conclusions. Comparing the present study with Cameriere et al's. [7] study, the study showed better results for mandibular canine with an R2 value of 85.40% as compared to an R2 value of 84.90% in the Cameriere's study. Separate linear regression equations were formulated for all teeth because correlation was stronger with individual tooth rather than the mean value of all teeth together in contrast with the study conducted by Kvaal et al., [6] in which the R2 value was strongest when the mean values (M, W − L) from all the six teeth were included together (R2 value of 76.00%) and weakest when only one type of tooth was considered. The present study also showed a statistical difference between chronological age and predicted age (S.E.E. between 5.889 years and 11.458 years) to be lesser than in Kvaal et al's. [6] study (S.E.E. between 8.6 and 11.5 years). Based on these variables, chronological age could be determined with an accuracy of 81.90% with Kvaal's and 93.50% with Cameriere's methods.

 Conclusion



Of all the morphological variables, variables such as p = complete pulp length/root length (from ECJ-root apex), r = complete pulp length/complete tooth length, mean (M), length (L) and pulp/tooth AR correlated significantly with age with variable p = complete pulp length/root length (from ECJ-root apex) correlating the best amongst them. Variables associated with width ratios (a = complete pulp length/root width at ECJ level, b = pulp/root width at midpoint level between ECJ level and midroot level and c = pulp/root width at midroot level) rather than length ratios (p = complete pulp length/root length (from ECJ-root apex) and r = complete pulp length/complete tooth length) correlated best with chronological age in the populace of Andhra Pradesh origin.

Limitations of the study

Though the results of the study are promising, it cannot be generalised to other populationsRotated teeth, decayed teeth or teeth with any prosthesis were excluded from the study. If the individual has any of the mentioned conditions, this method cannot be employed to estimate the age, as these conditions alter the tooth surface area.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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