Age Estimation

Using Secondary
Dentin
Manjiri Joshi
Neethu C
Parul Khare

OUTLINE title
Overview
What is secondary dentin?
How is secondary dentin formation and
age correlated
Why is it important in age estimation?
Quoting studies on age estimation using
secondary dentin classified as Destructive Technique
In-destructive Technique

MANJARI JOSHI

OVERVIEW
title

What is Secondary Dentin?

With the eruption of the teeth, and
especially with occlusal contact, the pulp
begins to receive the slight aggressive
effects
of
normal
biologic
function
(mastication,
light
thermal
changes,
chemical irritants, and slight traumas).
It is less permeable and also has less
dentinal tubules.
It is somewhat darker in color than the
primary dentine, and its tubules are more
curved, sometimes angulated, less regular,
and smaller in diameter.

How is Secondary Dentin

and age correlated?
With aging the pulp cavity gradually becomes smaller
because of continuous secondary dentin deposition. As a
consequence of this deposition there is a tendency toward
eventual pulp obliteration.
The pattern for the secondary dentin deposition varies
among the different groups of teeth. In maxillary anterior
teeth the greatest dentin deposition occurs on the palatal
wall of the pulp chamber with subsequent deposition in the
incisal tip and remaining walls of the pulp chamber.
In molars the greatest dentin deposition is on the floor of the
pulp chamber; lesser amounts are deposited on the occlusal
(biting) and lateral walls. In advanced age the secondary
denti becomes irregular and a gradual increasing loss of
dentinal tubules occurs

CLASSIFICATION
1. DESTRUCTIVE METHODS
. Sectioning of teeth is necessary.
. Hence can be used only in dead
individuals.
2. NON DESTRUCTIVE METHODS
.Age estimation using radiography (opg, CT,
CBCT etc)
.Can be used in NEETU.
dead as well
as living
C

DESTRUCTIVE METHODS

GUSTAFSONS METHOD
Sample size - 41 TEETH
6 PARAMETERS
ATTRITION
SECONDARY DENTIN FORMATION
PERIODONTITIS
CEMENTUM APPOSITION
ROOT RESORPTION
TRANSPARANCY OF ROOT
4 POINT SYSTEM

 FORMULA

Y= 11.43+4.56X
Y=AGE
X=(A+S+P+C+R+T)

Standard deviation +- 3.6years

How ever later studies were unable to
reproduce the same level of accuracy.
Accepted standard deviation +- 10 to
15years

DALITZ (1962)
Re evaluation of Gustafsons method
146 anterior teeth was examined
root resorption and secondary cementum
formation disregarded.
5 point system.

 FORMULA
E' = 5.1464' + 5.338P ' + 1.866s' + 8.411T
' + 8.691

Standard deviation
+- 6years ( when 4 anterior teeth
used)
+- 8.1 years( when single tooth is
used)

MAPLES (1978)
Sample size: 335 teeth
TOOTH POSITION as a factor along with
the 6 Gustafsons parameters
Multiple regression was carried out by
regressing each of the variables against
age.

 Second molar gives the best results

(tooth position 7)
Standard deviation +- 5.00years of
formula APSCT position 7 is the smallest
standard deviation for age estimation in
adults.
ST over all weighted formula gives best
results for all teeth and requires only
secondary dentin and root transparency.

SOLHEIM(1992)
Sample size 800 teeth(80 per tooth type)
selected measurements of different
dental parameters most related to age,
as found in various studies to present a
new method for dental age estimation
based on multiple regression analysis for
each type of tooth.

ARTICLES
Johanson (1971)
Metzger (1980)
Lamendin et al (1992)
Kiesal (1973)
Drusini (1993)
Ito(1972,1975)
Wei et al(1983)
Lopez Nicolas et al (1990)

NON DESTRUCTIVE
TECHNIQUES

PARUL KHARE

NON DESTRUCTIVE TECHINIQUESINTACT TEETH

LIVING

DEAD /
EXTRACTED
TEETH- INTACT

Kvall: Periapical- 1995

Vandevoort: Microfocus X-

Kristin M. Kolltveit, Tore Solheim

ray

Kvall -1998

tomography -2004

Bosmans: CT- 2005

Drusini: OPG- 2008

Yang Willems: CBCT - 2006

H. Aboshi: Microfocus X-ray

Hazha, Thevissen: CBCT - 2009

computed

Cameriere Lower premolars, OPG -

2010

2012

Jagannathan CBCT-2011

computed

tomography -

Kvall: age estimation of adults from dental

radiographs 1995
Age- 20-87 years
Sex - both
Sample size 100/Caucasian whites
Radiograph type periapical radiographs :Parallelling technique for
standard RX
Teeth 6
Maxillary Central and Lateral Incisors & Second Premolars
Mandibular Lateral Incisors, Canines and First Premolars.

Kvall: age estimation of adults from dental

radiographs 1995
Length and Width Ratios

Pulp Root Length (P)

Pulp Tooth Length (R)
Tooth Root Length (T)
Pulp Root Width at CEJ (A)
Pulp Root Width at Mid Root Level (C)
Pulp Root Width at Mid Point b/w
Level C & A (B)

Kristin , Solheim & Kvall-image analysis and

manual measurements. 1998
Aim: relationship between the size of the pulp and the tooth
Age: 20 to 87 years, and a mean age of 46
Sample size: 40 patients
Number of teeth: six teeth in each patient
Radiographs: periapical radiographs
Manual measurements: vernier callipers and a
stereomicroscope with a measuring eyepiece.
Computer assisted measurements: image analysis software.
Statistical analyses: Statistically significant intra- and interobserver differences between the manual and computerassisted measurements.
The results implied that, despite advanced technology,
conventional methods may be better suited for measuring
linear morphological parameters in dental tissue.
Kristin M. Kolltveit*, Tore Solheim, Sigrid I. Kvaal. Methods of measuring morphological parameters in dental radiographs
Comparison between image analysis and manual measurements. Forensic Science International 94 (1998) 8795.

BOSMANSA 2005
Aim: evaluate whether this approach feasible & adequate
repeatability when applied on panoramic radiographs.
Age: 19 to 75 years
Sample Size: 197
Radiographs : panoramic radiographs
Teeth: 6 teeth
Result: There appears to be no significant difference between
applying the original technique on standard long-cone
periapical radiographs or on orthopantomograms, especially
when carrying out measurements on all six selected teeth.
Recommended - panoramic radiographs, may lead to age
estimations that are comparable to those based on the original
technique. if at least the selection criteria are respected and
good quality orthopantomographs with clear radiological image
are used.
Nathalie Bosmansa, Peirs Annb, Medhat Alya, Guy Willems. The application of Kvaals dental age calculation
technique on panoramic dental radiographs. Forensic Science International 153 (2005) 208212

Studies based on KVALL: Australia 2014

Aim: to test the reliability and applicability of the method developed by
Kvaal et al.
Age range: females 2073 years (mean 36.73); males it is 2062 years
(mean 35.26).
Sex : 143 female and 136 male /Australian individuals
Sample size: 279 radiographs
Teeth: 6 teeth
Radiographs: digital orthopantomograms (OPG)
Results- most accurate model maxillary central incisor (SEE _9.367
years), maxillary second premolar (SEE _9.525 years). Regression
models based on the measurement of multiple teeth improved age
prediction accuracy (SEE _7.963 years).
This method, therefore, offers a statistically quantified methodological
approach for forensic age estimation in Western Australian adults.

Shalmira Karkhanis *, Peter Mack, Daniel Franklin Age estimation standards for a Western Australian population
using the dental age estimation technique developed by Kvaal et al. Forensic Science International 235 (2014)
104.e1104.e6

Studies based on KVALL: India 2014

Aim: Radiographs can be used to indirectly measure the rate of
secondary dentine deposition which is depicted by reduction in the pulp
area
Age: 18-72
Sample size: 200
Teeth 6 All the
Radiographs: Panoramic radiographs
Results: It was observed that 2 variables AR and bcontributed
significantly to the fit and were included in the regression model,
yielding the formula: Age = 87.305480.455(AR)+48.108(b).
Statistical analysis indicated that the regression equation with selected
variables explained 96% of total variance with the median of the
residuals of 0.1614 years and standard error of estimate of 3.0186
years.
Conclusion: There is significant correlation between age and
morphological variables AR and b and the derived population specific
regression equation can be potentially used for estimation of
chronological age of individuals of Karnataka origin.
Manjushree Juneja, Yashoda B. K. Devi1, N. Rakesh1, Saurabh Juneja2 Age estimation using pulp/tooth area ratio in maxillary
caninesA digital image analysis. Journal of Forensic Dental Sciences / September-December 2014 / Vol 6 / Issue 3

YANG, JACOBS & WILLEMS - 2006

Aim: attempt establishing a correlation between the chronological age of
a certain individual and the pulp/tooth volume ratio of one of the teeth.
Number of samples- 19 different individuals2
28 single rooted teeth
Age: 23 to 70 years of Teeth: 15 incisors, 12 canines, 1 premolar
Procedure of exposure - CBCT(skin dose 1.19 mSv, total dose 20 microSv
per examination).
A custom-made voxel counting software for calculating the ratio between
pulp canal versus tooth volume based on cone-beam CT tooth images
was developed and evaluated.
Results: showed a moderate correlation between the pulp/tooth volume
ratio and biological age with a coefficient of determination (R2) of 0.29.
Recommended: that the developed technique showed promising results
for dental age estimation in a non-invasive manner using cone-beam CT
images in living individuals.
Fan Yang a,b, Reinhilde Jacobs a, Guy Willems. Dental age estimation through volume matching of
teeth imaged by cone-beam CT. Forensic Science International 159S (2006) S78S83

Based on the fact that the

periodontal ligament space was
not clear in
An original cone-beam CT
most of the images, a manual preimage slice: which was
processing step was operated
exported as tiff 8 bits image
before segmentation.
format by the dedicated
After
image
magnification
in
software
iDixel after view was used to
(a)
The transparent
adjust
the
threshold of
paint
of Microsoft
Windows1
adjusting the window/
level
segmentation.
The observers
can set
different
parameters
to change
(Microsoft,
Seattle,
USA),
the
black
andsegmented
reslicing.
the
area. (b) The
curves
were the
drawn
along
the the
program labeled different segmented
regions,
figure
shows

HAZHA STAR & PATRICK THEVISSEN: 2011

Aim: dental age estimation based on the ratio between the
volume of the pulp and the volume of its corresponding tooth,
calculated on clinically taken cone beam computed tomography
(CBCT)
Age: 10 and 65 years
Sex: 57 female and 54 male patients
Sample size: 111 CBCT images (Scanora_3D dental cone beam
unit)
Teeth: 64 incisors, 32 canines, and 15 premolars
Statistical analysis: A linear regression model was fit with age as
dependent variable and ratio as predictor, allowing for
interactions of specific gender or tooth type.
Result: The strongest Pearson correlation coefficient between the
pulptooth volume ratio and age was measured on incisors.
Hazha Star,1 D.D.S.; Patrick Thevissen,1 M.Sc.; Reinhilde Jacobs,2 Ph.D.; Steffen Fieuws,3 Ph.D.;Tore Solheim,4
Ph.D.; and Guy Willems,1 Ph.D. Human Dental Age Estimation by Calculation of PulpTooth Volume Ratios Yielded on
Clinically Acquired Cone Beam Computed Tomography Images of Monoradicular Teeth. J Forensic Sci, January 2011,

Different separation and segmentation steps of an upper central incisor on CBCT DICOM data
imported in Simplant_ Pro software. To segment the selected tooth, a mask is created and an
optimal separating grayscale threshold is chosen on axial images showing the tooth root in bone.
The mask is cropped in three axes to limit it to the closest region of the chosen tooth, and a 3D
image is calculated (a). On this 3D calculation, regions not belonging to the tooth are selected and
roughly removed. Next slice by slice in each reproduction orientation manual erases and correcting
draws are performed to remove the cortical bone parts at root level and parts of the neighboring
teeth at crown level. This separation cannot be established by adapting the threshold because
there is a too small or no gray value difference between the involved structures. A 3D calculation of
the mask assembling all adapted slices generates an image on which the program can calculate
the tooth volume (b). At the inner side of the calculated image, a free space is available
corresponding with the pulp chamber (c). After adapting the segmentation by drawing a stop in the

CAMERIERE: PM -2012
Aim: of this paper is to examine the relationship between age and agerelated changes in the pulp/tooth area ratio in monoradicular teeth, with
the exception of canines,
Sex: 289 women and 317 men
Age: 18 and 75 years
Sample size: 606 orthopantomograms / Spanish white Caucasian patients
Radiographs- orthopantomography (OPG)
Regression analysis of age of monoradicular teeth indicated that the lower
premolars were the most closely correlated with age. Multiple regression
analysis, with age as dependent variable and pulp/tooth area ratio as
predictor, yielded several formulae.
R2 ranged from 0.69 to 0.75 for a single lower premolar tooth
0.79 to 0.86 for multiple lower premolar teeth.
Roberto Cameriere a, Stefano De Luca b,*, Inmaculada Aleman b, Luigi Ferrante c, Mariano
Cingolani. Age estimation by pulp/tooth ratio in lower premolars by orthopantomography. Forensic
Science International 214 (2012) 105112

Depending on the available number of premolar teeth, the mean of the

absolute values of residual standard error, at 95% confidence interval,
ranged between 4.34 and 6.02 years, showing that the pulp/tooth area ratio
is a useful variable for assessing age with reasonable accuracy.

CAMERIERE: CI & LI -2013

Aim: to examine the application of pulp/tooth area ratio as an
indicator of age in upper and lower incisors, both lateral and
medial.
Sex: 62 men and 54 women
Age: 18 and 74 years
Radiographs: peri-apical X-ray
Sample size: 116 individuals
Statistical analysis: The total variance explained by the
regression equation ranged from 51.3% of age, when lower
lateral incisors were used as explanatory variable, to 81.6%
when upper lateral incisors were used. The accuracy of the
corresponding regression model yielded ME 8.44 and 5.34
years, respectively.
Result: These results show that, although incisors are less
reliable than canines or lower premolars, they can be used to
Age estimate
estimation byage-at-death
pulp/tooth ratio in when
lateral and
central
incisors
peri-apical X-ray. R. Cameriere.
the
latter
are by
absent.
Cunha, S.N. Wasterlain, S. De Luca,E. Sassaroli, F. Pagliara, E. Nuzzolese, M.Cingolani, L. Ferrante.
Journal of Forensic and Legal Medicine 20 (2013) 530e536

Studies based on Cameriere: India 2014

Aim: Age estimation by pulp to tooth area ratio in canines
Sex: 114 males and 114 females
Age: 16-72 years
Sample size: 228 teeth
Teeth: 456 canines (upper, lower and both) in an Indian sample)
Exposure: radiovisiography technique
Result: Linear regression equations were derived for upper
canine, lower canine and both using the AR to estimate
chronological age.
The efficacy of these equations was also evaluated in younger
age group (<45 years).

M.B. Jeevan, Alka D. Kale, Punnya V. Angadi *, Seema Hallikerimath.Age estimation by pulp/tooth area ratio in canines:
Camerieres method assessed in an Indian sample using radiovisiography Forensic Science International 204 (2011) 209.e1

NON DESTRUCTIVETEETH INTACT

EXTRACTED/ DEAD

VANDEVOORT 2004
Aim: To correlate dental age with an individuals chronological age based on
the calculated volume ratio of pulp versus tooth volume measured
Exposure- X-ray microfocus computed tomography unit (CT) with 25m
spatial resolution
Sample size: 43 extracted single root teeth of 25 individuals
Analysis: custom-made analysis software 2 examiners, to obtain numerical
values for pulpal and tooth volume. The ratio of both showed no significant
intra- or inter-examiner differences.
Result: Linear regression analysis showed a coefficient of determination (r)
of 0,31 which suggests that there is a rather weak correlation between the
volume ratio of pulp versus tooth and biological age.
Recommendation: Although rather time consuming, this technique shows
promising results for dental age estimation in a non-destructive manner
using X-ray microfocus computed tomography.
Frieda M. Vandevoort, Lars Bergmans, Johan Van Cleynenbreugel, Didier J. Bielen, Paul Lambrechts, Martine Wevers, Ann Peirs and
Guy Willems.
Age Calculation Using X-ray Microfocus Computed Tomographical Scanning of Teeth: A Pilot Study

Reconstructed axial cross-section (a) showing segmentation of the hard

tissues (b) and the pulp (c).

DRUSINI 2008
Aim: The correlation between the reduction of the coronal pulp
cavity and the chronological age
Age- 9 to 76
Sex: 213 males and 220 females
Sample size: 846 intact teeth from 433 individuals
Teeth: 425 premolars and 421 molars / Caucasian
Exposure: Panoramic (rotational) radiography
Measure the
Length (mm) of the tooth crown (CL=coronal length)
Length (mm) of the coronal pulp cavity (CPCL=coronal pulp
cavity length).
The tooth-coronal index (TCI)

H. ABOSHI- 2010
Aim: develop an age estimation method based on the ratio of the
three-dimensional volume of the pulp chamber compared to the
total tooth.
Age: 2078 years
Sample size: 100
Teeth: 50 lower first and 50 lower second premolar
Exposure: microfocus X-ray computed tomography
Technique: Each specimen was imaged by a micro-CT the tooth
and pulp volumes at four levels
crown area (L1)
coronal one third (L2)
midroot (L3)
apical one third of the root (L4)
H. Aboshi *, T. Takahashi, T. Komuro. Age estimation using microfocus X-ray
computed tomography of lower premolars. Forensic Science International 200 (2010)

Correlation coefficients between age and volume variables showed that the ratio at the
region of coronal one third of the root (L2) correlated best whereas the apical one third
of the root (L4) correlated least with age in both lower first and second premolars.
Pulptooth volume ratios in lower premolars gradually reduced in value with increasing
age, with the steepest reduction occurring in the 2050 age range, and most noticeably
at the L2 level.
The result of multiple regression analysis by stepwise method provided good support for
the use of pulptooth volume measurements by microfocus X-ray computed
tomography of lower premolars in age estimation.

H. Aboshi *, T. Takahashi, T. Komuro. Age estimation using microfocus X-ray computed tomography of lower
premolars. Forensic Science International 200 (2010) 3540

JAGANNATHAN -2011
Aim: assesse the suitability of pulp/tooth volume ratio of mandibular
canines
Sample size: 188
Teeth: mandibular canines
Age: 10 to 70 years
Exposure- CBCT
Analysis: Age calculated using a formula reported earlier for a Belgian
sample
The regression equation obtained for the Indian population:
Age = 57.18 + (- 413.41 x pulp/tooth volume ratio)
Result: applied to an independent control group (n = 48), and this
resulted in mean absolute errors of 8.54 years which was significantly (p
< 0.05) lower than those derived with the Belgian formula.
The pulp/tooth volume ratio is a useful indicator of age, although
correlations may vary in different populations and hence, specific
formulae should be applied for the estimates.

N. Jagannathan,a P. Neelakantan,b C. Thiruvengadam,a P. Ramani,a P. Premkumar,a A. Natesan.

Age estimation in an indian population using Pulp/tooth volume ratio of mandibular canines
Obtained from cone beam computed tomography. J.S. Herald,a H. U. Luder. (J Forensic

Reconstructed
CT image of
tooth with
tooth volume
marked.

A cross-sectional
slice of the tooth
obtained by CT,
outlining the pulp
space

Volumetri
c
reconstru
ction of
pulp

Superimpos
ition of pulp
volume
reconstructi
on on tooth
volume
image.

DISADVANTAGES OF USING ONLY SECONDARY

DENTINE
FOR AGE ESTIMATION
In root-filled teeth there are no functioning odontoblasts and
thus no further secondary dentine formation, which, together
with an instrumental widening of the pulp, makes the tooth
unsuitable for measuring.
Parapulpal pins and crowns made difficult or impossible to
estimate pulpal morphology.
Apical pathological processes considered as a sign of pulpal
necrosis, and might represent a halt in production of secondary
dentine.
Totally impacted teeth remain, by definition, unexposed to the
functional conditions in the oral cavity, and formation of
secondary dentine is then a slower process than in functioning