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Comparison of the third molar maturity index (I3M) between left and right lower third molars to assess the age of majority: a multi-ethnic study sample

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Abstract

The diagnostic accuracy of the I3M to assess the legal age of 18 years has already been tested in several specific-population samples. The left lower third molar has been extensively used for discriminating between minors and adults. This research aimed to compare the usefulness of lower third molar maturity indexes, from both left and right side (I3ML and I3MR), in samples originating from four distinct continents in order to examine possible differences in their accuracy values. For this purpose, a sample of 10,181 orthopantomograms (OPGs), from Europe, Africa, Asia and America, was analysed and previously scored in other studies. The samples included healthy subjects with no systemic disorders with both third molars and clear depicted root apices. Wilcoxon Signed Rank test for left and right asymmetry did not show any significant differences. Data about sensitivity, specificity, predictive values, likelihood ratio and accuracy were pooled together and showed similar results for I3ML and I3MR, respectively. In addition, all these quantities were high when only the I3MR was considered to discriminate between adults and minors. The present referable database was the first to pool third molar measurements using panoramic radiographs of subjects coming from different continents. The results highlighted that both I3ML and I3MR are reliable indicators for assessing the legal age of 18 years old in those jurisdictions where this legal threshold has been set as the age of majority.

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Acknowledgements

The authors would like to thank Adriana Santos, Ana Rodrigues and Rui Santos, researchers from the Portuguese Institution CEAUL, under FCT – Fundação para a Ciência e a Tecnologia and the project UIDB/00006/2020, and the Clinic of Dentistry at the Universidad Científica del Sur (Perú).

Funding

Inês Oliveira-Santos is supported by a FCT-Fundação para a Ciência e Tecnologia grant (SFRH/BD/139158/2018).

Author information

Authors and Affiliations

  1. Department of Orthodontics and Dentofacial Orthopaedics, University of Bern, Bern, Switzerland

    N. Angelakopoulos

  2. AgEstimation Project, Macerata, Italy

    N. Angelakopoulos, I. Galić, S. B. Balla, A. Gulsahi, I. Soriano Vázquez, Stefano De Luca & R. Cameriere

  3. Department of Oral Surgery, School of Medicine, University of Split, Split, Croatia

    I. Galić

  4. Department of Forensic Odontology, Panineeya Institute of Dental Sciences and Research Center, Hyderabad, Telangana, India

    S. B. Balla

  5. Faculty of Dentistry, Oral and Maxillofacial Radiology, Nuh Naci Yazgan University, Kocasinan, Kayseri, Turkey

    H. C. Kiş

  6. Instituto Nacional de Patología Dr. Sergio Sarita Valdez, Santo Domingo, República Dominicana

    L. Gómez Jiménez

  7. Department of Forensic Medicine, I.M. Sechenov First Moscow State Medical University, Moscow, Russia

    G. Zolotenkova & R. Cameriere

  8. Design Information Technologies Centre, Russian Academy of Sciences (DITC RAS), Moscow, Russia

    G. Zolotenkova

  9. Centre for Oral & Maxillofacial Diagnostics and Medicine Studies, Faculty of Dentistry, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia

    M. Y. P. Mohd Yusof

  10. Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia

    M. Y. P. Mohd Yusof

  11. Department of Dental Morphology With Dental Anthropology and Forensics Faculty of Dentistry, University of Sarajevo, Sarajevo, Bosnia and Herzegovina

    A. Hadzić Selmanagić

  12. Department of Forensic Medicine and Toxicology, Seth GS Medical College and KEM Hospital, Mumbai, India

    H. Pandey

  13. Facultade de Medicina Dentária da Universidade de Lisboa, Lisboa, Portugal

    C. Palmela Pereira

  14. Postgraduate Program in Dentistry, Universidade Federal da Paraíba, João Pessoa, Paraíba, Brasil

    J. B. M. Nóbrega & I. L. Arrais Ribeiro

  15. Department of Oral Medicine and Periodontology, Faculty of Dental Sciences, University of Peradeniya, Kandy, Central Province, Sri Lanka

    K. Hettiarachchi

  16. Department of Forensic Odontology, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia

    S. M. Mieke

  17. Division of Forensic Odontology and Disaster Oral Medicine, Department of Forensic Science, Iwate Medical University, Iwate, Japan

    A. Kumagai

  18. Faculty of Dentistry, Dentomaxillofacial Radiology Department, Baskent University, Ankara, Turkey

    A. Gulsahi

  19. Laboratory of Anthropology, Institute of Anatomy, School of Medicine, University of Belgrade, Belgrade, Serbia

    K. Zelić

  20. School of Dental Medicine, University of Belgrade, Belgrade, Serbia

    K. Zelić

  21. Clinic for Orthodontics, School of Dental Medicine, University of Belgrade, Belgrade, Serbia

    N. Marinković

  22. Department of Orthodontics, Faculty of Medicine Alma Mater Europaea, University of Prishtina, Campus Rezonanca, Prishtina, Kosovo

    J. Kelmendi

  23. Department of Law, Institute of Legal Medicine, University of Macerata, Macerata, Italy

    I. Bianchi

  24. Department of Surgical Sciences, Section of Dentistry, University of Cagliari , Cagliari, Italy

    E. Spinas

  25. Forensic Dentistry, Scientific University of the South, Lima, Peru

    Y. W. Velezmoro-Montes

  26. Centre for Functional Ecology, Laboratory of Forensic Anthropology, Department of Life Sciences, University of Coimbra, Coimbra, Portugal

    I. Oliveira-Santos

  27. Área de Identificación Forense, Unidad de Derechos Humanos, Servicio Médico Legal, Santiago de Chile, Chile

    Stefano De Luca

  28. Private Dental Office, Beirut, Lebanon

    M. Moukarzel

Authors
  1. N. Angelakopoulos
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  2. I. Galić
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  3. S. B. Balla
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  4. H. C. Kiş
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  5. L. Gómez Jiménez
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  6. G. Zolotenkova
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  7. M. Y. P. Mohd Yusof
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  8. A. Hadzić Selmanagić
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  9. H. Pandey
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  10. C. Palmela Pereira
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  11. J. B. M. Nóbrega
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  12. K. Hettiarachchi
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  13. S. M. Mieke
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  14. A. Kumagai
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  15. A. Gulsahi
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  16. K. Zelić
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  17. N. Marinković
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  18. J. Kelmendi
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  19. I. Bianchi
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  20. I. Soriano Vázquez
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  21. E. Spinas
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  22. Y. W. Velezmoro-Montes
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  23. I. Oliveira-Santos
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  24. Stefano De Luca
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  25. I. L. Arrais Ribeiro
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  26. M. Moukarzel
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  27. R. Cameriere
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Corresponding author

Correspondence to Stefano De Luca.

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Ethics approval

This research study was conducted retrospectively from OPGs obtained for clinical purposes. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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According to the journal’s submission guidelines, an informed consent to participate in the study is not necessary for images such as x-rays.

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The authors declare no competing interests.

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Angelakopoulos, N., Galić, I., Balla, S.B. et al. Comparison of the third molar maturity index (I3M) between left and right lower third molars to assess the age of majority: a multi-ethnic study sample. Int J Legal Med 135, 2423–2436 (2021). https://doi.org/10.1007/s00414-021-02656-2

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