Dental age in kelantanese malay population based on demirjian's method
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Date
2009
Authors
Abu Asab, Saifeddin Halvied (Dr.)
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Abstract
Dental age has a great importance in age estimation for non-adult individuals,
helping the paediatric dentists and orthodontists to produce proper treatment plan,
and assessment of the dental developmental level of certain medical conditions.
Demirjian et a/. ( 1973) introduced a method of radiographic dental age in which the
calcification stages of the seven permanent mandibular teeth were assessed. The
method was revised in 1976 and two methods based four permanent teeth instead of
seven teeth were proposed (Demirjian and Goldstein, 1976). Demirjian's method is
still widely accepted and used in studies of radiographic dental age in different
geographic regions. The purposes of this study were 1) to examine the applicability
of Demirjian's methods (1973, and 1976) for estimating the chronological age of
male and female Kelantanese Malay children aged 5 to 16 years old, 2) to establish a
new dental age standard; if Demirjian's methods were not applicable on the
Kelantanese Malay population, 3) to compare the dental age curves between Malay
children and French-Canadian children, 4) to determine the sexual dimorphism in the
dental.,.qge assessment of Kelantanese Malay children, 5) to detect the differences in
'dental ages' and 'maturity scores' between the lower left permanent teeth and the
1ower right and 6) to detect the median ages of attainment of each stage of dental
development according to Demirjian stages for the lower left seven teeth. A total
number of 905 panoramic radiographs (OPG) of Kelantanese Malay children aged 5
to 16 years old have been collected from radiographic unit in the Universiti Sains
Malaysia (HUSM), and Orthodontic Dental Specialist Clinic - Hospital Raja.
Perempuan Zainab II (HRPZ II). The dental age has been assessed cross-sectionally
by using Demirjian's methods (1973, and 1976). Children who had any disease that
was known to affect the dental development. or have agenesis in the lower arch were
excluded, as well as, those poor quality OPG images. The intra and inter-examiner
reliability showed high values for 'maturity scoresĀ· and 'dental agesĀ·. Discrepancies
in staging the teeth did not exceed one stage more or less. The kappa values for the
agreement between the examiners were in good correlation. The results showed that
Demirjian's method (1973) overestimated the chronological age by 1.24 year for
boys and 1.27 years for girls, respectively. The 4 teeth: M2, M., PM2, PMt method
overestimated the age by 1.23 years for boys and 1.20 years for girls, respectively.
While 4 teeth: M2, PM2, PMt. I1 method overestimated the age by 0.64 year for boys
and 0.71 years for girls, respectively. As Demirjian's method (1973) was not
accurate on Kelantanese Malay children, new modified sex-specific dental age
standards for Kelantanese Malay were produced by modifying Demirjian's method
(1973). An external sample of 47 Kelantanese Malay children (23 boys and 24 girls)
was randomly selected from the Universiti Sains Malaysia Hospital (HUSM) in
order to test the accuracy of the mo.. dified Demirjian's method on Kelantanese Malay
population and results showed that the mean difference between the chronological
-age and dental age is about 2 weeks for both sexes. In comparison between the
dental development between Kelantanese Malay and French-Canadian children,
results showed that the 'dental age' for younger age groups of boys (7.0- 9.99 years)
was not statistically different from French-Canadian children (P > 0.05). However,
after the age 10 years, the difference became statistically significant in boys (P <
0.001 ). On the other hand, girls were more advanced in dental age as compared to
Canadian girls in all age groups as the difference was statistically significant (P <
;:
0.05). Both boys and girls have similar maturation at 6 years old with no statistically
significant difference between them. After the age group 6 years, the girls were more
advanced in dental age as compared to boys for all age groups (7.00- 10.99 years).
No significant difference was found in the dental development of the lower left teeth
when compared with the right lower teeth (P > 0.05). The median ages of attainment
of each developmental stage according to Dernirjians' stages for the lower
permanent left seven teeth for both sexes have been produced and showed that girls
are more advancement in dental age as compared to boys in all teeth except the first
molar. In conclusion, Demirjians' methods (1973, 1976) showed to be not accurate
to estimate the chronological age in Kelantanese Malay children samples. The
modification of the system had resulted in a new dental age system that is more
precise and more accurate for the Kelantanese Malay children. Dental age is more
advanced in Kelantanese Malay boys and girls as compared to French-Canadian
children in all age groups for girls and older age groups for boys (10 to 15.99 years).
Dental age is more advanced in Kelantanese Malay girls as compared to boys in all
age groups and in all stages of dental development. Dental developmen!_ is m
harmony in both sides of the lower jaw.
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Keywords
Demirjian's method , Malay population