Age estimation using orthopantomograms with demirjian and willems methods among children attending dental clinics in western Kenya

Abstract

An individual’s age forms an important part of their biodata and is not only necessary for the living but for the deceased. In addition, it is a vital requirement in identifying children who are victims of child abuse, trafficking and murder. Verification of an individual’s age can be done through authentic documents such as certificate of birth, national identity cards or passports. Nevertheless, there are situations where the age of an individual cannot be confirmed due to entrenched documents, hence the actual age has to be estimated. Therefore, various methods have been used to estimate age in different population among them being Demirjian and Willems methods that have widely been utilized. This has been achieved majorly through assessment of morphological changes of teeth as displayed by individual orthopantomograms. However, in Kenya, there is hardly any approved method that can be used to achieve this purpose, hence the need to determine the available methods in estimating the age of children in Western Kenya. Objective: To estimate age using orthopantomograms with Demirjian and Willems methods among children attending dental clinics in Western Kenya. Materials and methods: A cross-sectional study was conducted at Dental and Maxillofacial Imaging Centre in Kisumu County, Western Kenya. A total of 171 panoramic radiographs of children aged between 5-17 years were examined in order to determine the tooth maturity stages(A-H) for the first seven mandibular teeth on the left side. Each maturity stage was then assigned a corresponding maturity score as per Demirjian and Willems conversion tables, summed up and converted into dental age. The age difference was then obtained by subtracting dental age from chronological age. Descriptive and inferential statistics were used and data analyzed through SPSS version 26.0 and presented in tables and figures. Results: A sample of 171 panoramic radiographs of children aged 5-17 years were assessed, 91(54%) males and 80(46%) females. The study samples were divided into 6 age cohorts and comparison between sexes were tested. The mean chronological age for the entire age cohort was 9.11 years with a median age of 9.13 years. The overall mean dental age using Demirjian was 8.16±2.7. Among the females the deviation from the chronological age was ±2.22 years while in males it was ±1.68 at 95% CI. This depicted a wider margin of error in females than in males. There was an overall underestimation of the entire age cohort using Willems method with mean dental age of 8.94±2.264 with a standard error of 0.173 years. Among the females the deviation from the chronological age was ±2.062 years while in males it was ±1.95 at 95% CI. This depicted a wider margin of error in females than in males and a significant delay in dental maturity in both females and males. The comparison between dental age and chronological age was found not to be significant using both methods at P=<0.05. Pearson’s correlation test revealed a strong positive association between the dental and chronological age in both methods (r= 0.767). Demirjian had a strong association in only two age cohorts (7-8.99 & 9.-10.99 years) while Willems had a stronger association in four age cohorts (5-6.99, 7-8.99. 9-10.99, 11-12.99 years). Conclusion: Use of both Demirjian and Willems method resulted in statistically significant underestimation of age. In terms of accuracy, both methods had a strong positive correlation, however, Willems method was found to be more accurate in estimating age among children in Western Kenya because it had a strong association in majority of the age cohorts as compared to Demirjian.