Dental Age Estimation: A comparison of three methods of estimating dental age in a population of Kuwaiti children and adolescents

Abstract Background Dental age estimation using the simple average method utilizing the Demirjian 8 stage tooth developments system has not previously been compared to the 14 stage system of Moorrees. Neither method has been previously used nor compared with the Atlas method in a Kuwaiti population. The recent development of a Kuwait reference data set provides the means to determine which of these methods is the most accurate for age estimation in Kuwaiti subjects. Patients, materials and methods The sample was dental panoramic tomographs (DPTs) from the archives of Kuwait Ministry of Health Dental Hospitals comprising 375 healthy children aged between 5 and 15 years. Each of the anonymized DPT was assessed in random order and personal details masked from the observer. Results Intra and inter examiner agreement were calculated using Cohen's Kappa with scores of 0.76 or above which is ‘good to excellent’ agreement. The chronological age (CA) minus dental age (DA) difference using the simple average method (SAM) is an overestimate of 0.39 years for females and an underestimate of 0.14 years for males. The London Atlas overestimated the chronological age by 0.60 years for females and 0.19 years for males. Moorrees technique gave an underestimate of 1.01 years for females and 0.89 years for males. Bland-Altman plots showed an even distribution of difference around the chronological age. The Bland Altman plots showed the spread of the differences between chronological age and dental age for each of the three methods. Conclusions The simple average method was the most accurate within, 2–3 months of chronological age. The London Atlas and Moorrees methods were less accurate. This makes the simple average method the favoured technique for dental age estimation in a forensic science setting where ethnic specific reference data are important.