RESUMEN
The age threshold of 14 years is relevant in Italy as the minimum age for criminal responsibility. It is of utmost importance to evaluate the diagnostic accuracy of every odontological method for age evaluation considering the sensitivity, or the ability to estimate the true positive cases, and the specificity, or the ability to estimate the true negative cases. The research aims to compare the specificity and sensitivity of four commonly adopted methods of dental age estimation - Demirjian, Haavikko, Willems and Cameriere - in a sample of Italian children aged between 11 and 16 years, with an age threshold of 14 years, using receiver operating characteristic curves and the area under the curve (AUC). In addition, new decision criteria are developed to increase the accuracy of the methods. Among the four odontological methods for age estimation adopted in the research, the Cameriere method showed the highest AUC in both female and male cohorts. The Cameriere method shows a high degree of accuracy at the age threshold of 14 years. To adopt the Cameriere method to estimate the 14-year age threshold more accurately, however, it is suggested - according to the Youden index - that the decision criterion be set at the lower value of 12.928 for females and 13.258 years for males, obtaining a sensitivity of 85% and specificity of 88% in females, and a sensitivity of 77% and specificity of 92% in males. If a specificity level >90% is needed, the cut-off point should be set at 12.959 years (82% sensitivity) for females.
Asunto(s)
Determinación de la Edad por los Dientes/métodos , Adolescente , Niño , Femenino , Humanos , Italia , Masculino , Curva ROC , Radiografía Panorámica , Sensibilidad y EspecificidadRESUMEN
The 14-years age threshold is especially important in Italy for criminal, civil and administrative laws. Several methods relying on dental calcification of the teeth, up to the second molar, are used for the evaluation of age in childhood. The objective of the research was to compare the inter-rater agreement and accuracy of four common methods for the dental age estimation - Demirjian (D), Willems (W), Cameriere (C) and Haavikko (H) - in a sample of Italian adolescents between 11 and 16 years. The sensitivity and specificity, and the different level of probability, according to the peculiarities of Italian criminal and civil law, were compared for the methods examined, considering the threshold of 14 years. The sample was composed of 501 digital OPGs of Italian children (257 females and 244 males), aged from 11 years and 0 days to 15 years and 364 days. The maturation stage of the teeth was evaluated according to D, W, H and C methods by three independent examiners. Mixed statistical models were applied to compare the accuracy and the errors of each method. The inter-rater agreement was high for the four methods and the intraclass correlation coefficients were all ≥ 0.81. Methods H and C showed a general tendency to underestimate the age in the considered sample while the methods D and W tended to overestimate the child's age. In females, D and W were more accurate than C, which is more accurate than H. In the males, W is the most accurate method even though it over-estimated age. Considering the 14-years threshold, the sensitivity of D and W methods is quite high (range 0.80; 0.95) and specificity is low (range 0.61; 0.86). The principal findings of the research are: the W and D methods are much more accurate than C and H, but they tend to overestimate the age. The C method largely underestimates the age (by ~1 year) for both genders and for all operators. H is unsuitable for dental age estimation in the Italian population, while W and D yielded high sensitivity but low specificity, thus producing high rates of false positive results. The choice of method to estimate if an Italian child has reached the 14-years legal threshold should mainly be chosen according to the different legal milieu (if civil or criminal) and the gender of the examined individual. The age assessment in criminal case must be prudently managed.