RESUMO
SUMMARY: The present study aimed to investigate the utility of the proximal femur in the forensic age estimation by assessing changes in bone densities through radiographs. Using Otsu's threshold, bone density was quantified by counting all white pixel values within selected regions of interest, which include femoral head (FH), femoral neck (FN), Ward's triangle (WT), and greater trochanter (GT) from 354 left femora of Northern Thai descent. The pixel width of medullary cavity (MC) was also estimated. Furthermore, the study evaluated the performance of linear regression (LR) models for age estimation from radiographic images of proximal femora. Negative correlations were observed between FH, FN, WT, and GT pixel intensity with the age-at-death of the samples, with females exhibiting stronger correlations than males. Moreover, a positive correlation was found between age and MC width in female samples, while male MC widths did not show any relationship with increasing age. The results showed a slight difference between the LR model applied to both sexes, which integrated all variables, and the alternative configuration that only utilized relevant attributes. Both models exhibited similar performance, with a narrow range of root mean square error (RMSE) values, ranging from 12.67 to 12.71 years, and a correlation coefficient range of 0.51 to 0.52. For females, the LR model with FN and WT as selected attributes (RMSE = 11.85 years, correlation coefficient = 0.65) performed decently, while for males, the LR model with all variables showed RMSE of 12.52 years and correlation coefficient of 0.46. This study showcased the potential application of pixel intensity in predicting age.
El presente estudio tuvo como objetivo investigar la utilidad del fémur proximal en la estimación forense de la edad mediante la evaluación de cambios en las densidades óseas a través de radiografías. Utilizando el umbral de Otsu, la densidad ósea se cuantificó contando todos los valores de pixeles blancos dentro de regiones de interés seleccionadas, que incluyen la cabeza femoral (CF), el cuello femoral (CF), el triángulo de Ward (WT) y el trocánter mayor (TM) de 354 fémures izquierdos de ascendencia del norte de Tailandia. También se estimó el ancho de pixeles de la cavidad medular (CM). Además, el estudio evaluó el rendimiento de modelos de regresión lineal (RL) para la estimación de la edad a partir de imágenes radiográficas de fémur proximal. Se observaron correlaciones negativas entre la intensidad de los pixeles CF, CF, WT y TM con la edad de muerte, y las mujeres exhibieron correlaciones más fuertes que los hombres. Además, se encontró una correlación positiva entre la edad y el ancho del CM en muestras de mujeres, mientras que el ancho del CM del hombre no mostró ninguna relación con el aumento de la edad. Los resultados mostraron una ligera diferencia entre el modelo RL aplicado a ambos sexos, que integraba todas las variables, y la configuración alternativa que sólo utilizaba atributos relevantes. Ambos modelos mostraron un rendimiento similar, con un rango estrecho de valores del error cuadrático medio (RMSE), que oscilaba entre 12,67 y 12,71 años, y un rango de coeficiente de correlación de 0,51 a 0,52. Para las mujeres, el modelo RL con CF y WT como atributos seleccionados (RMSE = 11,85 años, coeficiente de correlación = 0,65) tuvo un desempeño satisfactorio, mientras que para los hombres, el modelo RL con todas las variables mostró un RMSE de 12,52 años y un coeficiente de correlación de 0,46. Este estudio mostró la posible aplicación de la intensidad de los pixeles en la predicción de la edad.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Determinação da Idade pelo Esqueleto/métodos , Antropologia Forense , Fêmur/diagnóstico por imagem , Tailândia , Radiografia , Densidade Óssea , Modelos LinearesRESUMO
Age estimation is crucial in legal and humanitarian contexts. Forensic professionals may use various procedures to estimate age, including dental analysis, bone density tests, evaluation of physical characteristics including facial bone structure and development, and image-based methods. Although images are often the only material available, visual observation of photographic material is an imprecise method in age estimation, which can compromise judicial decision-making. Analyzing 4000 photographs from the Brazilian Federal Police database, representing four age groups (6, 10, 14, and 18 years), the study employed automated analysis by marking 28 photogrammetric points. Data were used to establish facial patterns by age and sex using the facial geometric morphometrics method. Performance was assessed through a Multinomial Logistic Regression model, evaluating accuracy, sensitivity, and specificity across the categorical age groups. Analyses were conducted using R software, with a 5 % significance level. The study found that facial geometric morphometrics achieved an overall accuracy of 69.3 % in age discrimination, with higher accuracy in males (74.7 %) compared to females (65.8 %) (p < 0.001). The method excelled at predicting the age of 6-year-olds with 87.3 % sensitivity and 95.6 % specificity but had lower performance at 14 years. It showed greater accuracy in distinguishing age groups with larger age gaps, achieving up to 99.5 % accuracy between certain groups, and was particularly effective in differentiating ages of 6 and 10 years in females and 10, 14, and 18 years in males. The facial geometric morphometrics emerges as a promising approach for age estimation among children and adolescents in forensic settings.
Assuntos
Determinação da Idade pelo Esqueleto , Face , Fotografação , Humanos , Adolescente , Criança , Masculino , Feminino , Face/anatomia & histologia , Determinação da Idade pelo Esqueleto/métodos , Modelos Logísticos , Sensibilidade e Especificidade , Brasil , Fotogrametria , Antropologia Forense/métodosRESUMO
OBJECTIVES: This meta-analysis addresses the use of mandibular computed tomography (CT) scans for age and/or sex determination in forensic science. METHODS: Six databases were searched until June 2023, using the keyword "mandible" combined with keywords related to "multislice computed tomography" (MCT) or "cone-beam computed tomography" (CBCT) and keywords related to "skeletal age determination" or "sex determination analysis." MAIN RESULTS: Among the 23 studies included, 11 used MCT and 12 used CBCT to perform forensic assessments. Age determination was the aim of a single study, sex and agedeterminations were the objective of five studies, and the other studies investigated the determination of sex only. Metaanalysis could be performed only for sex determination. CONCLUSIONS: Mandible measurements are useful in sex determination, as the bicondylar and bigonial breadth are larger in males than in females. For the mandible angle, the meta-analysis results confirm sex dimorphism in CBCT scans but not in MCT scans. For age estimation, further studies are needed to prove that the mandible hole is a reliable parameter for age estimation. PROSPERO registration number: CRD42021260967.
Assuntos
Determinação da Idade pelo Esqueleto , Tomografia Computadorizada de Feixe Cônico , Mandíbula , Determinação do Sexo pelo Esqueleto , Humanos , Mandíbula/diagnóstico por imagem , Mandíbula/anatomia & histologia , Determinação do Sexo pelo Esqueleto/métodos , Determinação da Idade pelo Esqueleto/métodos , Tomografia Computadorizada Multidetectores , Antropologia Forense/métodosRESUMO
PURPOSE: To evaluate whether there is a mismatch between Risser staging and the proximal humerus ossification system (PHOS); and to analyze the correlation in the skeletal maturity stages between the two humeral epiphyses. METHODS: Data from patients aged 10 to 18 years with adolescent idiopathic scoliosis (AIS) seen between 2018 to 2021 were analyzed. In an anteroposterior (AP) spine radiograph the ossification process was evaluated using the Risser classification method and bilateral PHOS (if both humeral epiphyses were visualized). A mismatch between methods was defined as a Risser 0-1 (relatively skeletally immature) with a PHOS 4-5 (skeletally mature), or a Risser 2-5 (relatively skeletally mature) with a PHOS 1-3 (skeletally immature). The McNemar test was used to calculate the significance of the mismatch. RESULTS: A mismatch between Risser and PHOS stages was observed in 28.5% of 105 patients, which was statistically significant (p < 0.001). Of the 49 patients with a Risser 0-1, 55.1% (n = 27) had a PHOS 4-5. None of the patients with a Risser 2-5 had a PHOS 1-3. In the 47 patients in whom both humeri were visualized, the absolute correlation between the left and right PHOS values was 95.7%. CONCLUSION: Of AIS patients who are relatively skeletally immature according to Risser staging, more than half may be skeletally mature when measured with PHOS. In patients with a Risser 0-1, it is recommended to measure skeletal maturity in an AP spine radiograph using the PHOS method, which may more accurately guide treatment decision-making, without the need to visualize both humeral epiphyses in this radiographic projection. LEVEL OF EVIDENCE: IV.
Assuntos
Úmero , Osteogênese , Escoliose , Humanos , Escoliose/diagnóstico por imagem , Escoliose/patologia , Adolescente , Feminino , Criança , Masculino , Osteogênese/fisiologia , Úmero/diagnóstico por imagem , Úmero/crescimento & desenvolvimento , Úmero/patologia , Radiografia/métodos , Estudos Retrospectivos , Epífises/diagnóstico por imagem , Epífises/crescimento & desenvolvimento , Epífises/patologia , Índice de Gravidade de Doença , Determinação da Idade pelo Esqueleto/métodosRESUMO
SUMMARY: This review article will present an overview of biological profiles in forensic utilities. The biological profile of the skull in the existing literature can help to identify humans, especially if the condition of the victim found is a result of mutilation or a bomb explosion. When it comes to the precision of identifying skeletal remains, the human skull is frequently cited as being first in the estimation of age and ancestry and second in terms of sex and stature. It can be an alternative to assessing the following biological parameters: sex, age, stature, and ancestry. The implementation of biological profiles in the identification process is very important considering that some cases require the assistance of forensic anthropology. This review article shows the importance of the value of skulls. The method that can be applied is craniometry which can be used to determine sex, age, stature, and estimated ancestry. Different results will occur depending on the completeness of the skull. Therefore, estimation formulas have different accurate results. Discriminant function analysis has been performed on various measurement sets and its discriminant power has been validated by many researchers. Geometric morphometric analysis has become the main tool for shape analysis and many attempts have been made to use it in analyzing skulls. Several methods supported by technology have also been developed. It is hoped that the review article will show significant differences in results between studies in Thailand and Indonesia, even though they are in the same racial group.
Este artículo presenta una descripción general de los perfiles biológicos en las utilidades forenses. El perfil biológico del cráneo en la literatura existente puede ayudar a identificar a los humanos, especialmente si la condición en la que se encuentra la víctima es el resultado de una mutilación o la explosión de una bomba. Cuando se trata de la precisión en la identificación de restos óseos, el cráneo humano se cita con frecuencia como el primero en la estimación de edad y ascendencia y el segundo en términos de sexo y estatura. Puede ser una alternativa para evaluar los siguientes parámetros biológicos: sexo, edad, estatura y ascendencia. La implementación de perfiles biológicos en el proceso de identificación es importante considerando que algunos casos requieren la asistencia de la antropología forense. Este artículo de revisión muestra la importancia del valor de las cnezas óseas. El método que se puede aplicar es la craneometría para determinar el sexo, la edad, la estatura y la ascendencia estimada. Se pueden obtener diferentes resultados dependiendo de la integridad del cráneo. Por lo tanto, las fórmulas de estimación tienen resultados precisos diferentes. Se ha realizado un análisis de función discriminante en varios conjuntos de medidas y muchos investigadores han validado su poder discriminante. El análisis a través de la morfometría geométrica se ha convertido en la principal herramienta para el análisis de formas y se ha utilizado frecuentemente en el análisis de cráneos. También se han desarrollado varios métodos apoyados en la tecnología. Se espera que este trabajo muestre diferencias significativas en los resultados entre los estudios realizados en Tailandia e Indonesia, aunque pertenezcan al mismo grupo racial.
Assuntos
Humanos , Masculino , Feminino , Crânio/anatomia & histologia , Determinação da Idade pelo Esqueleto , Determinação do Sexo pelo Esqueleto , Linhagem , Tailândia , Estatura , IndonésiaRESUMO
BACKGROUND: Traditional methods for predicting adult height (AHP) rely on manual readings of bone age (BA). However, the incorporation of artificial intelligence has recently improved the accuracy of BA readings and their incorporation into AHP models. METHODS: This study aimed to identify the AHP model that fits the current average height for adults in Mexico. Using a cross-sectional design, the study included 1173 participants (5-18 yr). BA readings were done by two experts (manually) and with an automated method (BoneXpert®). AHP was carried out using both traditional and automated methods. The best AHP model was the one that was closest to the population mean. RESULTS: All models overestimated the population mean (males: 0.7-6.7 cm, females: 0.9-3.7 cm). The AHP models with the smallest difference were BoneXpert for males and Bayley & Pinneau for females. However, the manual readings of BA showed significant interobserver variability (up to 43% of predictions between observers exceeded 5 cm using the Bayley & Pinneau method). CONCLUSION: Traditional AHP models relying on manual BA readings have high interobserver variability. Therefore, BoneXpert is the most reliable option, reducing such variability and providing AHP models that remain close to the mean population height. IMPACT: Traditional models for predicting adult height often result in overestimated height predictions. The manual reading of bone age is prone to interobserver variability, which can introduce significant biases in the prediction of adult height. The BoneXpert method minimizes the variability associated with traditional methods and demonstrates consistent results in relation to the average height of the population. This study is the first to assess adult height prediction models specifically in the current generations of Mexican children.
Assuntos
Determinação da Idade pelo Esqueleto , Inteligência Artificial , Masculino , Criança , Adulto , Feminino , Humanos , Estudos Transversais , Determinação da Idade pelo Esqueleto/métodos , Estatura , MéxicoRESUMO
In 2013, midpalatal suture maturation stage assessment was proposed for the evaluation of patients before performing maxillary expansion. In this study, we aimed to analyze the association between the midpalatal suture maturation stages assessed by CBCT, according to the method described by Angelieri et al., and other objective methods used to assess skeletal maturation or bone fusion. A computerized database search was conducted using PubMed, Cochrane Library, SciELO, LILACS, Web of Science, and Scopus, without language restriction. Unpublished literature was searched on ClinicalTrials.gov, the National Research Register, and Pro-Quest Dissertation Abstracts and Thesis database. Authors were contacted when necessary, and reference lists of the included studies were screened. Search terms included midpalatal suture, maturation, correlation, diagnostic performance, classification, evaluation, assessment, and relationship. Quality assessment was performed using the Observational Cohort and Cross-Sectional Studies tool developed by the National Heart, Lung, and Blood Institute. Eleven studies met the inclusion criteria. Of all the studies included, 81.9% had fair qualit y and 18.1% good quality, respectively. Eight out of eleven studies assessed the correlation between the midpalatal suture maturation method and the skeletal maturity evaluated by CVM method (Spearman's correlation coefficient: 0.244-0.908). Two out of eleven studies evaluated the correlation between midpalatal suture maturation method and the skeletal maturity assessed by HWM method (Spearman's correlation coefficient: 0.904-0.905) Even though midpalatal suture maturation stage assessment needs an exhaustive training and calibration process, it is a valid method to evaluate skeletal maturation or bone fusion. From a clinical perspective, for patients at CS4, CS5 and CS6, an assessment of the midpalatal suture on CBCT is indicated. A similar assessment should be done in patients at SMI 7-9.
En 2013, se propuso un nuevo método para la evaluación del estadio de maduración de la sutura palatina mediana para la evaluación de los pacientes antes de realizar la expansión maxilar. En este estudio, nuestro objetivo fue analizar la asociación entre las etapas de maduración de la sutura palatina mediana evaluada en CBCT, según el método descrito por Angelieri et al., y otros métodos objetivos utilizados para evaluar la maduración esquelética o la fusión ósea. Se realizó una búsqueda en las bases de datos PubMed, Cochrane Library, SciELO, LILACS, Web of Science y Scopus, sin restricción de idioma. Se buscó literatura no publicada en ClinicalTrials.gov, el Registro Nacional de Investigación y la base de datos Pro-Quest Dissertation Abstracts and Thesis. Se estableció contacto con los autores cuando fue necesario y se revisaron las listas de referencias de los estudios incluidos. Los términos de búsqueda incluyeron sutura palatina mediana, maduración, correlación, rendimiento diagnóstico, clasificación, evaluación, valoración y relación. La evaluación de la calidad se realizó mediante la herramienta de Estudios transversales y de cohortes observacionales desarrollada por el Instituto Nacional del Corazón, los Pulmones y la Sangre. Once estudios cumplieron con los criterios de inclusión. Del total de estudios incluidos, el 81.9% tuvo calidad regular y el 18.1% calidad buena, respectivamente. Ocho de once estudios evaluaron la correlación entre el método de maduración de la sutura palatina mediana y la madurez esquelética evaluada por el método CVM (coeficiente de correlación de Spearman: 0.244-0.908). Dos de once estudios evaluaron la correlación entre el método de maduración de la sutura palatina mediana y la madurez esquelética evaluada por el método HWM (coeficiente de correlación de Spearman: 0.904-0.905). Aunque la evaluación del estado de maduración de la sutura palatina mediana necesita un proceso exhaustivo de entrenamiento y calibración, es un método válido para evaluar la maduración esquelética o la fusión ósea. Desde una perspectiva clínica, para pacientes en CS4, CS5 y CS6, está indicada una evaluación de la sutura palatina mediana en CBCT. Se debe realizar una evaluación similar en pacientes con SMI 7-9.
Assuntos
Determinação da Idade pelo Esqueleto/métodos , Técnica de Expansão Palatina , Suturas , Mandíbula/crescimento & desenvolvimentoRESUMO
This study verified the relationship between body size and skeletal age (SA) with the behavior of blood markers of muscle damage and delayed onset muscle soreness (DOMS) after a soccer match in the U-13 and U-15 categories. The sample consisted of 28 soccer players in the U-13 and 16 in the U-15 categories. Creatine kinase (CK), lactate dehydrogenase (LDH), and DOMS were evaluated up to 72 h after the match. Muscle damage was elevated at 0 h in U-13, and from 0 h to 24 h in U-15. DOMS increased from 0 h to 72 h in U-13 and from 0 h to 48 h in U-15. Significant associations of SA and fat-free mass (FFM) with muscle damage markers and DOMS were observed only in U-13, specifically at time 0 h, when SA explained 56% of CK and 48% of DOMS and FFM explained 48% of DOMS. We concluded that in the U-13 category, higher SA is significantly associated with muscle damage markers, and increase in FFM is associated with muscle damage markers and DOMS. Furthermore, U-13 players need 24 h to recover pre-match muscle damage markers and more than 72 h to recover DOMS. In contrast, the U-15 category needs 48 h to recover muscle damage markers and 72 h to recover DOMS.
Assuntos
Futebol , Humanos , Futebol/fisiologia , Músculo Esquelético , Determinação da Idade pelo Esqueleto , Biomarcadores , Mialgia , Creatina Quinase , Tamanho CorporalRESUMO
Age-at-death estimation is a difficult task in fragmented or incomplete contexts. The generation and testing of methods are needed to identify their potential application in different types of osteological samples. This paper proposes a new method for age estimation using the first rib. Four hundred and fifteen individuals from the Coimbra Identified Skeletal Collections (Portugal) were studied; the sample was divided in two groups (reference and test samples), used to develop the procedure and to evaluate its reliability. The three rib joints and two variables (surface texture and topography, and periarticular margins and subsidence of the surface) were recorded. Statistical analyses were performed to test the procedure reproducibility, and side and sex variations. Posterior probabilities were calculated following Bayesian statistics and used to estimate the most likely age-at-death in the test sample. The results show the reproducibility of the method is adequate, left and right ribs can be indistinctly recorded, and both sexes show similar change patterns. The costal face and the head epiphyseal region offered satisfactory results and the percentages of correct estimations are greater for younger individuals, decreasing as ages-at-death are higher. This method is more effective among individuals in the 20-50 years cohort; nevertheless, it also offered satisfactory estimates in older ones. Overestimations in individuals younger than 40 years and underestimations in individuals older than 75 years were identified. In conclusion, the first rib offer adequate estimates when a basic probabilistic approach is chosen. Whenever possible, this proposal must be included in a multifactorial perspective with other age markers.
Assuntos
Antropologia Forense , Costelas , Adulto , Masculino , Feminino , Humanos , Idoso , Antropologia Forense/métodos , Reprodutibilidade dos Testes , Teorema de Bayes , Costelas/anatomia & histologia , Epífises , Determinação da Idade pelo Esqueleto/métodosRESUMO
Abstract This study aimed to investigate the possibility of age and sex determination using bimastoid diameter with cone-beam computed tomography (CBCT). This retrospective study investigated 100 female and 100 male patients aged 18-83 years (mean age: 45.55±16.28 years). To measure bimastoid diameter, the appropriate image was chosen from sagittal, coronal, and axial images of CBCT in which the measurement points could be best detected. The distance between the points of the mastoid process was measured using three-dimensional coronal reconstruction. The mean bimastoid breadth was 106.12±6.22mm. The bimastoid diameter in male cases was higher than that in female cases (110.69±4.53mm vs. 101.65±4.00mm). There was no significant difference in bimastoid breadth with advancing age. For sex determination, morphometric measurements of bimastoid diameter ensured a high rate of dimorphism in the Turkish subpopulation. CBCT morphometric analysis may be reliable and convenient for evaluating sex and may be recommended to compare population data.
Resumen Este estudio tuvo como objetivo investigar la posibilidad de determinar la edad y el sexo utilizando el diámetro bimastoideo con tomografía computarizada de haz cónico (CBCT). Este estudio retrospectivo investigó a 100 mujeres y 100 hombres de entre 18 y 83 años (edad media: 45,55±16,28 años). Para medir el diámetro bimastoideo, se eligió la imagen adecuada de las imágenes sagital, coronal y axial de CBCT en las que los puntos de medición se podían detectar mejor. La distancia entre los puntos del proceso mastoideo se midió mediante reconstrucción coronal tridimensional. La amplitud media del bimastoide fue de 106,12± 6,22mm. El diámetro del bimastoide en los casos masculinos fue mayor que en los casos femeninos (110,69±4,53 mm frente a 101,65±4,00mm). No hubo diferencias significativas en la amplitud del bimastoide con la edad. Para la determinación del sexo, las mediciones morfométricas del diámetro bimastoide aseguraron una alta tasa de dimorfismo en la subpoblación turca. El análisis morfométrico CBCT puede ser confiable y conveniente para evaluar el sexo y puede recomendarse para comparar datos poblacionales.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Tomografia Computadorizada de Feixe Cônico , Processo Mastoide/anatomia & histologia , Determinação da Idade pelo Esqueleto , Determinação do Sexo pelo EsqueletoRESUMO
BACKGROUND: Hand-wrist radiography is the gold standard for the assessment of skeletal age (SA) and the assignment of biological maturation (BM) status. However, its practical use in the field is questioned, prompting the development of anthropometric equations to estimate BM. However, there is no consensus on the reliability of these equations in relation to hand-wrist X-rays. OBJECTIVE: To test the reliability of the BM estimated from predictive equations with the results of hand-wrist X-rays. METHODS: One-hundred forty-four young athletes (38%-males, 62%-females; 12.3 ± 1.4 years) were recruited. SA was assessed by analyzing X-rays of the hand-wrist using the Greulich-Pyle protocol. SA was predicted using the anthropometric equations of Cabral and Macêdo. By subtracting chronological age from SA, a measure of BM or biological age (BA) was computed. In addition, a BA of years from peak height velocity (PHV) was predicted using the anthropometric equations of Mirwald and Moore. RESULTS: Relative to X-ray, Cabral's equations showed high reliability in estimating BM in both sexes (p < .0001) while Macêdo's equations showed substantial reliability or males (p < .0001) only. Mirwald and Moore's equations showed weak reliability (p < .05 and p = .043, respectively). CONCLUSION: The prediction of SA using anthropometric equations was found to be reliable in categorizing individuals as late, synchronized, and/or early maturers in both sexes. However, the predictive equations of years from PHV only reliably categorized late and synchronized maturation stages in males and the synchronized maturers in females.
Assuntos
Determinação da Idade pelo Esqueleto , Punho , Determinação da Idade pelo Esqueleto/métodos , Feminino , Humanos , Masculino , Radiografia , Reprodutibilidade dos Testes , Punho/diagnóstico por imagem , Raios XRESUMO
Abstract: In forensic and legal contexts, an assessment of skeletal maturation is required to predict the chronological age in certain circumstances in which the chronological age is undocumented or unable to be proven. Carrying such medical examinations will always pose an ethical concern, especially in cases of assessing sexual maturity as well as examinations involving ionizing radiation. The cultural and religious barriers are also discussed concerning the ethical standards set in Saudi Arabia. Several ethical issues concerning age estimation examinations including issues related to consent forms, privacy, and radiation hazards have been documented. While ethical issues regarding radiation hazards are more likely to be overcome by introducing other imaging modalities without radiation hazards, ethics related to consent forms and privacy are still to be improved.
Resumen: En contextos forenses y legales, se requiere la evaluación de la maduración del esqueleto para predecir la edad cronológica en ciertas circunstancias en que la edad cronológica no está documentada o no es posible de probar. Realizar tales exámenes médicos siempre significa una preocupación ética, especialmente en casos de evaluación de madurez sexual así como en exámenes que involucran radiaciones ionizantes. Se discuten también las barreras culturales y religiosas relacionadas con el contexto de estándares éticos en Arabia Saudita. Entre los varios temas éticos relacionados con la estimación de la edad, se documentan temas relacionados con los formularios de consentimiento, privacidad y riesgos de radiación. Mientras que los temas éticos relacionados con riesgos de radiación pueden ser resueltos al introducir otras modalidades de examen sin radiación, los problemas éticos relacionados con los formularios de consentimiento y privacidad todavía necesitan mejorarse.
Resumo: Em contextos forenses e legais, uma avaliação de maturação esquelética é requerida para predizer a idade cronológica em certas circunstâncias nas quais a idade cronológica não é documentada ou impossível de ser provada. Conduzir tais exames médicos sempre irá suscitar uma preocupação ética, especialmente em casos para avaliar maturidade sexual bem como exames envolvendo radiação ionizante. As barreiras culturais e religiosas também são discutidas no que diz respeito a padrões éticos estabelecidos na Arábia Saudita. Diversos aspectos éticos concernentes a exames de estimativa de idade incluindo aspectos relacionados a formulários de consentimento, privacidade e risco de radiação foram documentados. Ao passo que aspectos éticos que dizem respeito a risco de radiação serem mais provavelmente superáveis pela introdução de outras modalidades de exames de imagem sem risco de radiação, a ética relacionada a formulários de consentimento e privacidade ainda estão por serem melhorados.
Assuntos
Humanos , Determinação da Idade pelo Esqueleto/ética , Riscos de Radiação , Medicina Legal/ética , Arábia Saudita , Privacidade , Consentimento Livre e EsclarecidoRESUMO
OBJECTIVE: To assess the evidence on the relationship between dental and cervical vertebrae maturation. MATERIALS AND METHODS: Searches were performed (up to December 2021) in seven databases, as well as in gray literature. Studies that included growing subjects, which evaluated the correlation between the stages of tooth formation and the maturation of cervical vertebrae, were eligible. The methodological quality of the selected reports was assessed using the JBI checklist for cross-sectional studies. Random-effects meta-analyses were implemented to calculate the pooled correlation coefficients between the maturation stages of cervical vertebrae and each tooth type. The GRADE approach was followed to assess the certainty of evidence. RESULTS: Seventy-seven studies were selected. Most of them had limitations related to sampling and reliability of the methods to evaluate maturation. The syntheses evidenced positive correlations between the maturation of cervical vertebrae and the formation/calcification stages of the following lower teeth: canine (n = 7318; r = 0.692; 95% CI: 0.656-0.724), first premolar (n = 6194; r = 0.689; 95% CI: 0.649-0.725), second premolar (n = 6194; r = 0.695; 95% CI: 0.659-0.729), and second molar (n = 7905; r = 0.698; 95% CI: 0.652-0.739). All estimates were affected by the risk of bias and the presence of unexplained statistical heterogeneity. CONCLUSIONS: The evidence points to an apparent positive correlation between dental and cervical vertebrae maturation. These results need to be carefully evaluated as the body of evidence is of very low quality. CLINICAL RELEVANCE: Dental maturation might be a potential indicator of skeletal craniofacial growth status. A routine dental x-ray could be sufficient, reducing radiation exposure by requesting additional radiographs.
Assuntos
Determinação da Idade pelos Dentes , Calcificação de Dente , Determinação da Idade pelo Esqueleto/métodos , Determinação da Idade pelos Dentes/métodos , Dente Pré-Molar , Cefalometria/métodos , Vértebras Cervicais/diagnóstico por imagem , Estudos Transversais , Humanos , Reprodutibilidade dos TestesRESUMO
OBJECTIVE: This study aimed to establish a correlation between the stages of tooth calcification of mandibular canines and second molars with the phases of skeletal development. METHODS: In a consecutive series of panoramic, cephalometric and hand-wrist radiographs of 113 individuals (60 females and 53 males) with an average age of 12.24 ± 1.81 years, the stages of mandibular canine and second molar calcification, cervical vertebrae maturation indicators (CVMI) and skeletal maturity indicators (SMI) were classified. The variables were correlated by means of the Spearman's Rank test: chronological age, SMI, CVMI and tooth calcification stages. In order to assess whether the CVMI and tooth calcification stages were significant predictors of the SMI, an ordinal regression analysis was carried out. RESULTS: The stages of CVMI (OR = 16.92; CI 95% = 6.45-44.39; p< 0.001) and calcification of the second molars (OR = 3.22; CI 95% = 1.50-6.92; p= 0.003) were significant predictors of SMI, however similar result was not observed for canines (OR = 0.52, CI 95% = 0.18-1.54; p= 0.239). Calcification stage E for boys, and E and F for girls corresponded to the pre-peak phase of pubertal growth. Stages G and H for boys, and F and G for girls coincided with peak of growth. In the final growth phase, the majority of second molars presented with root apex closure (stage H). CONCLUSION: The stages of calcification of the second molar may be considered predictors of the stage of skeletal development in the population studied.
Assuntos
Determinação da Idade pelos Dentes , Adolescente , Determinação da Idade pelo Esqueleto , Cefalometria , Vértebras Cervicais/diagnóstico por imagem , Criança , Feminino , Humanos , Masculino , Radiografia Panorâmica , Calcificação de DenteRESUMO
ABSTRACT Objective: This study aimed to establish a correlation between the stages of tooth calcification of mandibular canines and second molars with the phases of skeletal development. Methods: In a consecutive series of panoramic, cephalometric and hand-wrist radiographs of 113 individuals (60 females and 53 males) with an average age of 12.24 ± 1.81 years, the stages of mandibular canine and second molar calcification, cervical vertebrae maturation indicators (CVMI) and skeletal maturity indicators (SMI) were classified. The variables were correlated by means of the Spearman's Rank test: chronological age, SMI, CVMI and tooth calcification stages. In order to assess whether the CVMI and tooth calcification stages were significant predictors of the SMI, an ordinal regression analysis was carried out. Results: The stages of CVMI (OR = 16.92; CI 95% = 6.45-44.39; p< 0.001) and calcification of the second molars (OR = 3.22; CI 95% = 1.50-6.92; p= 0.003) were significant predictors of SMI, however similar result was not observed for canines (OR = 0.52, CI 95% = 0.18-1.54; p= 0.239). Calcification stage E for boys, and E and F for girls corresponded to the pre-peak phase of pubertal growth. Stages G and H for boys, and F and G for girls coincided with peak of growth. In the final growth phase, the majority of second molars presented with root apex closure (stage H). Conclusion: The stages of calcification of the second molar may be considered predictors of the stage of skeletal development in the population studied.
RESUMO Objetivo: O presente estudo objetivou estabelecer uma correlação entre os estágios de calcificação dentária de caninos e segundos molares inferiores e as fases do desenvolvimento esquelético. Métodos: Em uma série consecutiva de radiografias panorâmicas, cefalométricas e de mão e punho de 113 indivíduos (60 meninas e 53 meninos) com idade média de 12,24 ± 1,81 anos, foram classificados os estágios de calcificação do canino e do segundo molar inferiores, indicadores de maturação das vértebras cervicais (IMVC) e indicadores de maturação esquelética (IME). As variáveis foram correlacionadas pelo teste de Correlação de Rank de Spearman: idade cronológica, IME, IMVC e estágios de calcificação dentária. A fim de avaliar se os estágios do IMVC e da calcificação dentária foram preditores significativos do IME, foi realizada uma análise de regressão ordinal. Resultados: Os estágios de IMVC (OR = 16,92; IC 95% = 6,45-44,39; p< 0,001) e calcificação dos segundos molares (OR = 3,22; IC 95% = 1,50-6,92; p= 0,003) foram preditores significativos de IME; no entanto, esse não foi o caso com dentes caninos (OR = 0,52, IC 95% = 0,18-1,54; p= 0,239). Os estágios de calcificação E para meninos e E e F para meninas corresponderam à fase pré-pico de crescimento puberal. Os estágios G e H para meninos e F e G para meninas coincidiram com o pico de crescimento. Na fase final de crescimento, a maioria dos segundos molares apresentou fechamento do ápice radicular (estágio H). Conclusão: Os estágios de calcificação do segundo molar podem ser considerados preditores do estágio de desenvolvimento esquelético na população estudada.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Determinação da Idade pelos Dentes , Calcificação de Dente , Determinação da Idade pelo Esqueleto , Radiografia Panorâmica , Vértebras Cervicais/diagnóstico por imagem , CefalometriaRESUMO
ABSTRACT Objective: To evaluate dental age assessment reliability through Tooth Coronal Index (TCI) method. Material and Methods: The cone-beam computed tomography (CBCT) scans of 160 individuals aged between 20-70 years were analyzed in the present study. The height of the crown, i.e., coronal height, and the height of the coronal pulp cavity, i.e., coronal pulp cavity height, of mandibular second premolars and first molars were calculated and then TCI was measured. The actual age of a subject was compared with TCI of tooth and the acquired data were subjected to Pearson's correlation and unpaired t-tests. Results: Negative correlation was observed between the real age and TCI of mandibular first molar (r = -0.094, p=0.382) and second premolar (r = -0.176, p=0.0961. Statistically significant difference was observed between actual age and TCI for mandibular second premolar and first molar (p<0.001). Conclusion: Tooth coronal index has the potential to estimate age of an individual on CBCT scans. It is simple, cost-effective than histological methods and can be applied to both living and unknown dead.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Diagnóstico por Imagem/instrumentação , Determinação da Idade pelo Esqueleto , Tomografia Computadorizada de Feixe Cônico/instrumentação , Dente Pré-Molar/anatomia & histologia , Estatísticas não Paramétricas , Dente Molar/anatomia & histologiaRESUMO
Growth is the task of children. We review the normal process of linear growth from the fetus through adolescence and note that growth is the result of age- and gender-dependent interactions among key genetic, environmental, dietary, socioeconomic, developmental, behavioral, nutritional, metabolic, biochemical, and hormonal factors. We then define the wide range of normative data at each stage of growth and note that a pattern within this range is generally indicative of good general health and that growth significantly slower than this range may lead to growth faltering and subsequent short stature. Although not often emphasized, we detail how to properly measure infants and children because height velocity is usually determined from two height measurements (both relatively large values) to calculate the actual height velocity (a relatively much smaller number in comparison). Traditionally the physiology of growth has been taught from an endocrine-centric point-of-view. Here we review the hypothalamic-pituitary-end organ axes for the GH/IGF-1 and gonadal steroid hormones (hypothalamic-pituitary-gonadal axis), both during "mini"-puberty as well as at puberty. However, over the past few decades much more emphasis has been placed on the growth plate and its many interactions with the endocrine system but also with its own intrinsic physiology and gene mutations. These latter, whether individually (large effect size) or in combination with many others including endocrine system-based, may account in toto for meaningful differences in adult height. The clinical assessment of children with short stature includes medical, social and family history, physical exam and importantly proper interpretation of the growth curve. This analysis should lead to judicious use of screening laboratory and imaging tests depending on the pre-test probability (Bayesian inference) of a particular diagnosis in that child. In particular for those with no pathological features in the history and physical exam and a low, but normal height velocity, may lead only to a bone age exam and reevaluation (re-measurement), perhaps 6 months later. he next step depends on the comfort level of the primary care physician, the patient, and the parent; that is, whether to continue with the evaluation with more directed, more sophisticated testing, again based on Bayesian inference or to seek consultation with a subspecialist pediatrician based on the data obtained. This is not necessarily an endocrinologist. The newest area and the one most in flux is the role for genetic testing, given that growth is a complex process with large effect size for single genes but smaller effect sizes for multiple other genes which in the aggregate may be relevant to attained adult height. Genetics is a discipline that is rapidly changing, especially as the cost of exome or whole gene sequencing diminishes sharply. Within a decade it is quite likely that a genetic approach to the evaluation of children with short stature will become the standard, truncating the diagnostic odyssey and be cost effective as fewer biochemical and imaging studies are required to make a proper diagnosis.
Assuntos
Transtornos do Crescimento/diagnóstico , Crescimento/fisiologia , Adolescente , Determinação da Idade pelo Esqueleto/métodos , Teorema de Bayes , Estatura/genética , Estatura/fisiologia , Criança , Pré-Escolar , Feminino , Interação Gene-Ambiente , Testes Genéticos/tendências , Crescimento/genética , Transtornos do Crescimento/etiologia , Hormônio do Crescimento/metabolismo , Lâmina de Crescimento/fisiologia , Humanos , Sistema Hipotálamo-Hipofisário/fisiologia , Lactente , Recém-Nascido , Fator de Crescimento Insulin-Like I/metabolismo , Masculino , Anamnese , Exame Físico , Puberdade/fisiologia , Fatores SexuaisRESUMO
BACKGROUND: Skeletal age (SA) is considered the best method of assessing biological maturation. The aim of this study was to determine intra-observer (reproducibility) and inter-observer agreement of SA values obtained via the Greulich-Pyle (GP) method. In addition, the variation in calculated SAs by alternative GP protocols was examined. METHODS: The sample was composed of 100 Portuguese female soccer players aged 12.0-16.7 years. SAs were determined using the GP method by two observers (OB1: experience < 100 exams using GP; OB2: experience > 2000 exams using several methods). The radiographs were examined using alternative GP protocols: (wholeGP) the plate was matched to the atlas as an overall approach; (30-boneGP) bone-by-bone inspections of 30-bones; (GPpmb) bone-by-bone inspections of the pre-mature bones only. For the 30-boneGP and GPpmb approaches, SA was calculated via the mean (M) and the median (Md). RESULTS: Reproducibility ranged 82-100% and 88-100% for OB1 and OB2, respectively. Inter-observer agreement (100 participants multiplied by 30 bones) was 92.1%. For specific bones, agreement rates less than 90% were found for scaphoid (81%), medial phalange V (83%), trapezium (84%) and metacarpal V (87%). Differences in wholeGP SAs obtained by the two observers were moderate (d-cohen was 0.79). Mean differences between observers when using bone-by bone SAs were trivial (30-boneGP: d-cohen less than 0.05; GPpmb: d-cohen less than 0.10). The impact of using the mean or the median was negligible, particularly when analyses did not include bones scored as mature. CONCLUSION: The GP appeared to be a reasonably reproducible method to assess SA and inter-observer agreement was acceptable. There is evidence to support a recommendation of only scoring pre-mature bones during later adolescence. Further research is required to examine whether these findings are consistent in younger girls and in boys.
Assuntos
Determinação da Idade pelo Esqueleto , Futebol , Adolescente , Criança , Feminino , Humanos , Masculino , Variações Dependentes do Observador , Radiografia , Reprodutibilidade dos TestesRESUMO
Abstract Introduction: According to the literature, the amount of osteons has been suggested as a good proxy to determine the age of death in adults. However in subadults research has not been carried out yet. Objective: To determine the accuracy of the histomorphometric technique predicting the age at death in subadults using bone remains. Methodology: The information of static histomorphometric parameters from about 120 iliac bones retrieved from the exhumed remains of subadults whose age at death was known was taken from the Granada collection. In order to predict the age at death we performed a step by step linear regression to estimate the fittest model. Results: The most closely and significantly associated biopsy findings with age were: the osteon count, the internal cortical width, and the trabecular bone volume. Pearson's correlation index indicated a weak linear association among these variables. To assess the accuracy of the model we used a coefficient of determination with a 0.32 value. 32% of the age variation in the subadults was explained by the three variables. Conclusion: This regression model explains a percentage of the total age variation in the subadult population. However this model is not enough to determine the age at death.
Resumen Introducción: La capacidad de predicción de las osteonas para determinar la edad de muerte de los individuos ha sido descrito en la literatura científica. No obstante, no se ha determinado dicha capacidad en individuos subadultos. Objetivo: Determinar la eficacia de lo parámetros histomorfometricos en población subadulta. Metodología: Se realizaron biopsias de hueso ilíaco en los restos de 120 subadultos, de la Colección Osteológica de Granada, con edad conocida en el momento de la muerte. Para establecer la capacidad de predicción se utilizó el R2 obtenido a partir de regresión lineal múltiple. Resultados: Las variables con mayor nivel predictivo y significativo para la estimación de la edad fueron: recuento de osteonas tipo 2 de la cortical interna y externa, y el volumen óseo trabecular; En la evaluación del modelo, se obtuvo un coeficiente de determinación de 0.32, es decir, el 32% de la variación en la edad de los subadultos se explica por el modelo. Sin embargo, se evidenció diferencias en la capacidad de predicción por sexo. Conclusión: Este modelo de regresión explica un porcentaje sustancial de la varianza de la edad de los individuos en la muestra. No obstante, no es suficiente para garantizar una adecuada predicción de la edad al momento de muerte de los individuos subdultos.
Assuntos
Humanos , Determinação da Idade pelo Esqueleto , Ílio , Análise dos Mínimos Quadrados , Modelos Lineares , Ósteon , HistologiaRESUMO
The classical age indicators of the innominate have been the pubic symphysis and auricular surface. However, recently, the acetabulum has been highlighted as an indicator of adult age, with applicability in young, middle-aged, and older adults. The Rissech acetabular method was developed in a Portuguese population and tested in European and European-Americans, giving estimates within 10 years of age in more than 89% of the sample. The main goal of this paper is to test the Rissech acetabular method in a modern South American sample. The material used for the study was 184 women and 378 men from a Colombian-documented skeletal collection. The obtained morphological scores from the acetabulum were analyzed through the IDADE2 web page, a Bayesian statistical program that estimates a relative likelihood distribution for the target individuals, produces age estimates, and provides 95% confidence intervals. Results showed this method is useful in the modern Colombian population with an average absolute error of 10.63 years in females and 9.44 years in males. These errors are similar to those obtained in other European and North American samples when this method was performed and similar or lower than those obtained when the 3 classical aging methods (Suchey-Brooks, Buckberry-Chamberlain, and Lovejoy) were applied in the same collection (absolute error: 10.29 years â and 9.05 years â in Suchey-Brooks, 12.5 years â, and 12.17 years â in Buckberry-Chamberlain, and 13.54 years â and 10.99 years â in Lovejoy). Although Rissech's method was developed in a Western European sample, the results of this study indicate its applicability in modern Colombian samples with reasonable accuracy.