Chapter 1. General Introduction, Aims and Objectives
1.2 Study objectives
The following objectives are designed to address the development of dental aging reference values for Black Southern Africa populations:
1. Conduct a meta-analysis of published articles to determine the accuracies of the Demirjian and Willems methods of age estimation. (Chapter 2)
2. Develop dental maturity scores for Southern African Black children using Demirjian’s method and compare the findings with other populations. (Chapter 3)
3. Investigate the accuracy of the Original Demirjian, Modified Demirjian and Willems methods of age estimation in Southern African Black children. (Chapter 4)
4. Determine the influence of nutrition (as measured by height, weight, mid-upper arm circumference and head circumference) on tooth formation. (Chapter 5)
5. Determine the reference values for tooth emergence in Black Southern African children and compare the results with other populations. (Chapter 6)
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6. Determine the influence of sex and nutrition (measured by the anthropometric variables height, weight, mid-upper arm circumference and head circumference) on tooth emergence.
(Chapter 7)
7. Examine the association among life history variables (sexual maturity, skeletal growth, brain development) and dental development (tooth formation and emergence). (Chapter 8) 8. Develop a population-specific reference for tooth formation and emergence (the WITS
Atlas). (Chapter 9)
1.3 Methodology
The methods used in this study are presented in each of the research chapters.
30 1.4 References
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Orthod, 88(5), 433-438.
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Contents
Chapter 2 ... 35 The Demirjian versus the Willems methods for dental age estimation in different
populations: A meta-analysis of published studies ... 35 Abstract ... 36 2.1 Introduction and Context ... 38 2.2 Background ... 41 2.3 Methodology ... 44 2.3.1 Systematic Literature Search ... 44 2.3.2 Data collection from accepted trials and analysis ... 46 2.3.3 Pooling of datasets ... 48 2.3.4 Assessment of methodological quality ... 48 2.3.5 Assessment of publication bias risk ... 49 2.3.6 Statistical Analysis ... 49 2.4 Results ... 49 2.4.1 Literature Search ... 49 Identification ... 51 Screening ... 51 Eligibility ... 51 Included ... 51 2.4.2 Pooled meta-analysis of studies using the Demirjian method to determine difference
in the dental age versus chronological age in males and females ... 56 2.4.3 Pooled meta-analysis of studies using the Willems method to determine difference in
the dental age versus chronological age in males and females ... 57 2.4.4 Pooled meta-analysis of studies comparing the Willems and Demirjian methods in
males ... 64 2.4.5 Pooled meta-analysis of studies comparing the Willems and Demirjian methods in
females ... 64 2.4.6 Evaluation of heterogeneity and publication bias ... 67 2.5 Discussion ... 70 2.5.1 Comparison between chronological age and dental age using Demirjian’s method71 2.5.2 Comparison between ... 71 2.5.3 Comparison between the Willems and Demirjian methods ... 72 2.5.4 Variation in dental development in human populations: Implications for age
estimation... 72
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Conflicts of interest ... 74 Acknowledgements ... 74 2.6 References ... 75 Appendix I ... 83
35 Chapter 2
The Demirjian versus the Willems method for dental age estimation in different populations: A meta-analysis of published studies
Temitope A Esan1,2¶, Veerasamy Yengopal3¶, Lynne A Schepartz1¶*
1 Human Variation and Identification Unit, School of Anatomical Sciences,
Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
2 Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife, Nigeria
3Department of Community Dentistry, School of Oral Health Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
*Corresponding Author: Lynne A Schepartz E-mail: [email protected] (LAS)
¶ These authors contributed equally to this work
36 Abstract
Background: The accuracy of radiographic methods for dental age estimation is important for biological growth research and forensic applications. Accuracy of the two most commonly used systems (Demirjian and Willems) has been evaluated with conflicting results.
This study investigates the accuracies of these methods for dental age estimation in different populations.
Methods: A search of PubMed, Scopus, Ovid, Database of Open Access Journals and Google Scholar was undertaken. Eligible studies published before December 28, 2016 were reviewed and analyzed. Meta-analysis was performed on 28 published articles using the Demirjian and/or Willems methods to estimate chronological age in 14,109 children (6,581 males, 7,528 females) age 3-18 years in studies using Demirjian’s method and 10,832 children (5,176 males, 5,656 females) age 4-18 years in studies using Willems’ method. The weighted mean difference at 95% confidence interval was used to assess accuracies of the two methods in predicting the chronological age.
Results: The Demirjian method significantly overestimated chronological age (p<0.05) in males age 3-15 and females age 4-16 when studies were pooled by age cohorts and sex. The majority of studies using Willems’ method did not report significant overestimation of ages in either sex. Overall, Demirjian’s method significantly overestimated chronological age compared to the Willems method (p<0.05). The weighted mean difference for the Demirjian method was 0.62 for males and 0.72 for females, while that of the Willems method was 0.26 for males and 0.29 for females.
Conclusion: The Willems method provides more accurate estimation of chronological age in different populations, while Demirjian’s method has a broad application in terms of determining maturity scores. However, accuracy of Demirjian age estimations is confounded
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by population variation when converting maturity scores to dental ages. For highest accuracy of age estimation, population-specific standards, rather than a universal standard or methods developed on other populations, need to be employed.
Systematic review protocol registration number is: CRD42016029995
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CHAPTER 2: SYSTEMATIC LITERATURE REVIEW OF DENTAL AGE