Dental and Skeletal Age Estimations in Lebanese Children: A Retrospective Cross-sectional Study

Abstract

Aims and objectives: Assessing dental and bone ages is frequently required in a wide range of fields such as odontology, forensic science, as well as orthopedics. The aim of this study was to evaluate applicability of two methods of bone age assessment and two methods of dental age (DA) assessment for Lebanese children.

Materials and methods: Skeletal age (SA) of 260 orthodontic patients (124 males, 136 females divided into four groups each) was consecutively assessed using Greulich and Pyle and Fishman's SMI methods. DA was evaluated using both Demirjian's and Willem's methods. Mean age was 11.89 ± 1.38 years for males and 11.75 ± 1.58 years for females. Data were collected and statistically analyzed using the SPSS software (IBM SPSS Statistics, version 21, USA). The differences between estimated DA, estimated SA, and chronological age (CA) were compared by gender and age group.

Results: Greulich and Pyle method showed nonsignificant difference with CA in male sample, while in both assessment methods, the difference between skeletal and CAs is significant in female sample. Results of Willem's method in the whole sample suggested a statistically nonsignificant difference, when compared to CA. Demirjian's method delivered higher mean value than Willem's assessment in both genders.

Conclusions: Greulich and Pyle method is accurate for SA assessment in males and only in one group of females, while it significantly overestimates age in all other female groups. Willem's method is more suitable to assess DA in both genders. A strong correlation exists between both dental and skeletal assessment methods and CA.

Keywords: Dental age; Lebanese children; hand-wrist radiograph; skeletal age.

Figure 1

Panoramic radiograph of patient aged 11 years, 3 months. Demirjian's method rates each of the lower seven left teeth on a maturity scale from A to H. Here, apex of incisors and first molar are closed, which corresponds to the last stage of dental formation (H), while the second premolar is on Stage G, and the second molar is on Stage F. Dental age is 12.9 years according to Demirjian's method, and 12.38 years following Willem's method

Figure 2

Hand wrist of the same patient showing different sites (in white and red) of skeletal maturity indicator (SMI) at epiphyseal plates assessed in Fishman's method. Skeletal age according to Greulich and Pyle Atlas is 13 years, 6 months. For Fishman's method, SMI 5 (in red) is depicted here, with capping of distal phalanx epiphysis of third finger, and skeletal age is 13 years

Figure 3

Mean age difference (at 95% confidence interval) of the four estimation methods for both males and females. Chronological age: blue for Demirjian, green for Willem's, yellow for Greulich and Pyle, and red for Fishman's methods