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Title Willems Is a Relatively Accurate Method of Dental Age Estimation as Compared to Demirjian
Clinical Question Is the Willems method of dental age estimation accurate than the Demirjian method in estimating the chronological of children and adolescents?
Clinical Bottom Line In children, Willems method is a relatively more accurate method for estimating the age of children and adolescents. This is based on five meta-analyses that showed lower difference between the chronological and the dental age for the Willems vs. the Demirjian method. Willems method is becoming widely adopted because it is less likely to overestimate the chronological age, which is commonly reported using the Demirjian method.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 23756500Jayaraman/2013Demirjian method: 19599 subjects (9708 males and 9891 females) aged 2 to 21 years. Meta-Analysis
Key resultsOverestimation of age of 0.65 years for females and 0.60 years for males was reported. The overall difference between the chronological and dental age ranged from -0.08 years to +3.04 years for males and -0.10 years to +2.82 years for females. Meta-analysis was conducted that showed significant difference in the estimated age among different population groups with an average overestimation of over 6 months (p<0.0001).
#2) 24367690 Yan/2013Demirjian method: 11499 subjects (5301 males and 6198 females) aged 3 to 17 yearsMeta-Analysis
Key resultsSignificant difference between the dental age and the chronological age of 0.35 years was observed for boys (95% CI = 0.17-0.52, P<0.001). Similarly, for girls, the overall difference was 0.39 years (95% CI: 0.18-0.61, P <0.001). The difference was 0.24 years for Asians and 0.52 years for Caucasians. The Demirjian’s method overestimated the age of all children between 5 to 14 years old.
#3) 28958768Mohd Yusof/2017Willems method: 13,915 children (6,476 males and 7,169 females) aged 3 to 16 years.Meta-Analysis
Key resultsBased on the overall pooled estimate, this method overestimated the age of males by 0.10 years (95% CI: 0.06 to 0.26) and females by 0.09 years (95% CI: 0.09 to 0.19). Overall, for both genders, the difference ranged from 0.01 years to 0.69 years. For both genders, significant heterogeneity was observed between the studies and it ranged from 70.1 to 97.1% (p<0.0001).
#4) 23756500Wang/2017Willems method: 9,347 children (4,386 males and 4,961 females) aged 4 to 18 years.Meta-Analysis
Key resultsThe weighted mean difference was 0.18 years in males was not significant (95% CI= -0.50 to 0.41, p=0.125). In females, the dental age and chronological age was not significant for females at 0.06 years (95% CI = -0.23 to 0.36, p=0.685). Overestimation of age was found in all age cohorts except 8-year old and 13- to 15-year old children.
#5) 29117240 Esan/2017Demirjian method: 14109 subjects (6581 males and 7528 females) aged 4 to 18 years. Willems method: 10,832 children (5,176 males and 5,656 females) aged 3 to 18 years.Meta-Analysis
Key resultsDemirjian’s method overestimated the age of males in majority of the studies. Based on the meta-analysis, the weighted mean difference (WMD) between the dental age and the chronological age was 0.62 years in males (95% CI (0.56, 0.66)) and 0.72 years in females (95% CI (0.69, 0.75)). For Willems method, significant difference was seen between the estimated dental age and the chronological age of 0.26 years in males (95% CI (0.20, 0.32)) and 0.29 years in females (95% CI (0.24, 0.35)).
Evidence Search ((((((demirjian) OR demirjian's) OR willems) AND "dental age") OR "age estimation" OR "age assessment") AND "meta-analysis")
Comments on
The Evidence
Jayaraman et al. reported the first ever systematic review on dental age estimation and based on the Demirjian’s method, they found significant over estimation of age in global population groups. The method employed in this study was consistent with that of other studies. This included adherence to the PRISMA reporting guidelines, thorough & exhaustive search for studies using two or more databases, independent assessment by at least two authors when reviewing the articles for inclusion, and separate reporting of qualitative and quantitative data, including the age difference in decimal year format.
Applicability Age estimation is an important procedure in clinical dentistry to assess the growth of an individual for diagnosis and treatment planning. In forensic dentistry, it is used to estimate age of individuals without authentic birth documents and those involved in false age claims. From the included studies, it has been found that the Demirjian’s method significantly overestimated the age of subjects belonging to global populations by an average of 6 months. Willems standard, which is an adaptation of the Demirjian’s original dental maturity scores, showed relatively accurate estimates of age.
Specialty/Discipline (Public Health) (Oral Medicine/Pathology/Radiology) (Orthodontics) (Pediatric Dentistry)
Keywords Demirjian; Willems; Dental age; Dental maturity; Age estimation; Age determination by teeth
ID# 3391
Date of submission: 11/22/2019spacer
E-mail jayaraman@livemail.uthscsa.edu
Author Jayakumar Jayaraman, BDS, MDS, FDSRCS, PhD
Co-author(s) Sheetal Asher, BDS, DMD
Co-author(s) e-mail ashers@livemail.uthscsa.edu
Faculty mentor/Co-author Maria Jose Cervantes Mendez, DDS, MS
Faculty mentor/Co-author e-mail cervantesmen@uthscsa.edu
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