The Importance of Methods for Determination of Squeletal and Dental Age in Orthodontics and Pediatric Dentistry – A Literature Review The Importance of Methods for Determination of Squeletal and Dental Age in Orthodontics and Pediatric Dentistry – A Literature Review
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Published:
Oct 19, 2023
Keywords:
Age Determination by Skeleton, Age Determination by Teeth, Carpal Bones, Cone-Beam Computed Tomography, Radiography Dental
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Abstract
The stage of human development is closely related to bone or dental maturity, being essential for the choice of treatment for dentofacial changes in children and adolescents by orthodontists and pediatric dentists. There are several biological indicators to determine an individual's maturation, such as chronological age and hormonal changes, but these indicators can suffer interference. Aiming at a more accurate determination of development and growth peaks, for a better diagnosis and treatment plan, several methods have been developed to determine skeletal age and dental age, these being the assessment of carpal maturation, the morphology of the cervical vertebrae, bone fusion of the spheno-occipital synchondrosis and the median palatal suture, as well as the stages of dental calcification. The evaluation of hand and wrist radiographs is the gold standard for predicting skeletal age, and its correlation with other methods is already evident. Therefore, it is possible to use the assessment of cervical vertebrae and dental ages by Nolla and Demirjian.
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Garcia Lopes, J., Caroline Tomé Barreto, B., Otero Amaral Vargas, E., Melo Magalhães, K., Issamu Nojima, L., & da Cunha Gonçalves Nojima, M. (2023). The Importance of Methods for Determination of Squeletal and Dental Age in Orthodontics and Pediatric Dentistry – A Literature Review. Naval Dental Jounal, 50(2), 46-53. https://doi.org/10.22491/25149.50-2-6
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Literature Reviews
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
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2. Marcondes E. Idade óssea em pediatria. Pediat. 1980;2:297-311.
3. Haiter Neto F. Análise comparativa manual e computadorizada da estimativa da idade óssea pelo índice de Eklöf & Ringertz [tese]. Bauru: Universidade de São Paulo; 1995.
4. Chertkow S, Fatti P. The relationship between tooth mineralization and early radiographic evidence of ulnar sesamoid. Angle Orthod. 1979;49(4):282-8.
5. Rodriguez CYA, Arriola-Guillen LE, Flores-Mir C. Björk-Jarabak cephalometric analysis on CBCT synthesized cephalograms with different dentofacial sagittal skeletal patterns. Dental Press J Orthod. 2014;19(6):46-53.
6. Moraes MEL, Médici Filho E, Moraes LC. Surto de crescimento puberal. Relação entre mineralização dentária, idade cronológica, idade dentária e idade óssea – método radiográfico. Rev Odontol UNESP. 1998;27(1):111-29.
7. Greulich WW, Pyle SI. Radiographic atlas of skeletal development of the hand and wrist. 2a ed. Stanford: Stanford University Press; 1959.
8. Lamparski DC. Skeletal age assessment utilizing cervical vertebrae [dissertação]. Pittsburgh: University of Pittsburgh; 1972.
9. Hassel B, Farman AG. Skeletal maturation evaluation using cervical vertebrae. Am J Orthod Dentofacial Orthop. 1995;107(1):58-66.
10. Baccetti T, Franchi L, McNamara JA Jr. An improved version of cervical vertebral maturation (CVM) method for the assessment of mandibular growth. Angle Orthod. 2002;72(4):316-23.
11. Bassed RB, Briggs C, Drummer OH. Analysis of time of closure of the spheno-occipital synchondrosis using computed tomography. Forensic Sci Int. 2010;200(1-3):161-4.
12. Angelieri F, Cevidanes LH, Franchi L, Gonçalves JR, Benavides E, McNamara JA Jr. Midpalatal suture maturation: classification method for individual assessment before rapid maxillary expansion. Am J Orthod Dentofacial Orthop. 2013;144(5):759-69.
13. Nolla CM. The development of permanent teeth. J Dent Child. 1960;27(4):254-66.
14. Demirjian A, Goldstein H, Tanner JM. A new system of dental age assessment. Hum Biol. 1973;45(2):211-27.
15. Garn SM, Rohmann CG. Variability in the order ossification of the bony centers of the hand and wrist. Am J Phys Anthropol. 1960;18(3):219-30.
16. Guzzi BSS, Carvalho LS. Estudo da maturação óssea em pacientes jovens de ambos os sexos através de radiografias de mão e punho. Ortodontia. 2000;33(3):49-58.
17. Koc A, Karaoglanoglu M, Erdogan M, Kosecik M, Cesur Y. Assessment of bone ages: is the Greulich-Pyle method sufficient for Turkish boys? Pediatr Int. 2001;43(6):662-5.
18. Breen AB, Steen H, Pripp A, Hvid I, Horn J. Comparison of different bone age methods and chronological age in prediction of remaining growth around the knee. J Pediatr Orthop. 2023;43(6):386-91.
19. Yeong-Senga Y, Ting Ywan C, Jeffrey CC. Applicability of the Greulich and Pyle bone age standards to Taiwanese children: a Taipei experience. J Chin Med Assoc. 2022;85(7):767-73.
20. Yeong-Senga Y, Ting Ywan C, Tao-Hsine T. Bone age assessment: large-scale comparison of Greulich-Pyle method and Tanner-Whitehouse 3 method for Taiwanese children. J Chin Med Assoc. 2023;86(2):246-53.
21. Wang YM, Tsai TH, Hsu JS, Chao MF, Wang YT, Jaw TS. Automatic assessment of bone age in Taiwanese children: a comparison of the Greulich and Pyle method and the Tanner and Whitehouse 3 method. Kaohsiung J Med Sci. 2020;36(11):937-43.
22. Faustino-da-Silva YV, Martinho DV, Coelho-E-Silva MJ, Valente-Dos-Santos J, Conde J, Oliveira TG, et al. Reproducibility and inter-observer agreement of Greulich-Pyle protocol to estimate skeletal age among female adolescent soccer players. BMC Pediatr. 2020;20(1):494.
23. Koc U, Taydaş O, Bolu S, Elhan AH, Karakas SP. The Greulich-Pyle and Gilsanz-Ratib atlas method versus automated estimation tool for bone age: a multi-observer agreement study. Jpn J Radiol. 2021;39(3):267-72.
24. Booz C, Yel I, Wichmann JL, Boettger S, Kamali AA, Albrecht MH, et al. Artificial intelligence in bone age assessment: accuracy and efficiency of a novel fully automated algorithm compared to the Greulich-Pyle method. Eur Radiol Exp. 2020;4(1):6
25. Fishman LS. Can cephalometric x-rays of the cervical column be used instead of hand-wrist x-rays to determine patient's maturational age? Am J Orthod Dentofacial Orthop. 2022;122(1):18A-19A.
26. García-Fernandez P, Torre H, Flores L, Rea J. The cervical vertebrae as maturational indicators. J Clin Orthod. 1998;32(4):221-5.
27. Flores-Mir C, Burgess CA, Champney M, Jensen RJ, Pitcher MR, Major PW. Correlation of skeletal maturation stages determined by cervical vertebrae and hand-wrist evaluations. Angle Orthod. 2006;76(1):1-5.
28. Gandini P, Mancini M, Andreani F. A comparison of hand-wrist bone and cervical vertebral analyses in measuring skeletal maturation. Angle Orthod. 2006;76(6):984-9.
29. Damian MF, Woitchunas FE, Cericato GO, Cechinato F, Moro G, Massochin ME, et al. Análise da confiabilidade e da correlação de dois índices de estimativa da maturação esquelética: índice carpal e índice vertebral. Rev Dent Press Ortodon Ortop. 2006;11(5):110-20.
30. Uysal T, Ramoglu SI, Basciftci FA, Sari Z. Chronologic age and skeletal maturation of the cervical vertebrae and hand-wrist: Is there a relationship? Am J Orthod Dentofacial Orthop. 2006;130(5):622-8.
31. Caldas MP, Ambrosano GMB, Haiter-Neto F. Computer assisted analysis of cervical vertebral bone age using cephalometric radiographs in Brazilian subjects. Braz Oral Res. 2010;24(1):120-6.
32. Al Khal HA, Wong RWK, Rabie ABM. Elimination of hand-wrist radiographs for maturity assessment in children needing orthodontic therapy. Skeletal Radiol. 2008;37(3):195-200.
33. Gabriel DB, Southard KA, Qian F, Marshall SD, Franciscus RG, Southard TE. Cervical vertebrae maturation method: poor reproducibility. Am J Orthod Dentofacial Orthop. 2009;136(4):478.e1-7; discussion 478-80.
34. Baccetti T, Franchi L, McNamara JA Jr. The cervical vertebral maturation (CVM) method for the assessment of optimal treatment timing in dentofacial orthopedics. Semin Orthod. 2005;11(3):119-29.
35. Carelli J, Madalena IR, Mattos C, Morais ND, Lopes, CMCF, Scariot, R, et al. Avaliação da correlação entre maturação esquelética e maturação dentária em crianças brasileiras. RSBO. 2020;17(2):162-71.
36. Alqadi MA, Abuaffan AH. The reliability of Fishman and Nolla methods in prediction of chronological age of Yemeni children. Braz Dent Sci. 2020;23(3):1-9.
37. Magat G, Ozcan S. Assessment of maturation stages and the accuracy of age estimation methods in a Turkish population: a comparative study. Imaging Sci Dent. 2022;52(1):83-91.
38. Amasya H, Yildirim D, Aydogan T, Kemaloglu N, Orhan K. Cervical vertebral maturation assessment on lateral cephalometric radiographs using artificial intelligence: comparison of machine learning classifier models. Dentomaxillofac Radiol. 2020;49(5):20190441.
39. Scheuer L, Black S. Developmental juvenile osteology. San Diego: Elsevier Academic Press; 2000.
40. Ennes J, Consolaro A. Sutura palatina mediana: avaliação do grau de ossificação em crânios humanos. Rev Dent Press Ortodon Ortop Facial. 2004;9(5):64-73.
41. Silva C, Goldberg T, Teixeira A, Dalmas J. Mineralização óssea em adolescente do sexo masculino: anos críticos para a aquisição da massa óssea. J Pediatr. 2004;80(6):461-7.
42. Marshall D. Radiographic correlation of hand, wrist, and tooth development. Dental Radiog Photogr. 1976;49(3):51-72.
43. Ferreira ER Jr, Pinto LAMS, Pinto RS. Estágio de mineralização dental: 1. análise comparativa entre os sexos. Rev Odontol UNESP. 1993;22(2):303-13.
44. Bolaños MV, Manrique MC, Bolaños MJ, Briones MT. Approaches to chronological age assessment based on dental calcification. Forensic Sci Int. 2000;110(2):97-106.
45. Rossi RR, Amorim SG, Pacheco MCT. Correlação entre estágios de mineralização dos dentes e estimativa da maturação esquelética. Ortodontia. 1999;32(3):48-58.
46. Chhaparwal Y, Kumar M, Madi M, Chhaparwal S, Pentapati KC. Age estimation by modified Demirjian’s method in a hospital-based population: a radiographic study. Pesqui Bras Odontopediatria Clín Integr. 2021;21:e0137.
47. Han MQ, Jia SX, Wang CX, Chu G, Chen T, Zhou H, et al. Accuracy of the Demirjian, Willems and Nolla methods for dental age estimation in a northern Chinese population. Arch Oral Biol. 2020;118:104875.
48. Gonçalves LS, Machado ALR, Gaêta-Araujo H, Recalde TSF, Oliveira-Santos C, Silva RHA. A comparison of Demirjian and Willems age estimation methods in a sample of Brazilian non-adult individuals. Forensic Imaging. 2021;25:20045.
49. Barati S, Khafri S, Rahmati Kamel M, Sheikhzade S, Abesi F, et al. Comparison of Demirjian and Willems methods in estimating dental age and modification of Willems method for 7 - 15 year olds Iranian population. Iran J Pediatr. 2022;32(5):e122126.
50. Mónico LS, Tomás LF, Tomás I, Varela-Patiño P, Martin-Biedma B. Adapting Demirjian standards for Portuguese and Spanish children and adolescents. Int J Environ Res Public Health. 2022;19(19):12706.
51. Filipović G, Djordjević NS, Stojanović NM, Brkić Z, Igić M, Marjanović D, et al. Evaluation of chronological age based on third-molar development in the Serbian population. Vojnosanit Pregl. 2020;77(10):1054-9.
52. Yassin SM, Al Almai BAM, Ali Huaylah SH, Althobati MK, AlHamdi FMA, Togoo RA. Accuracy of estimating chronological age from Nolla’s Method of dental age estimation in a population of Southern Saudi Arabian children. Niger J Clin Pract. 2020;23(12):1753-8.
53. Marrero-Ramos MD, López-Urquía L, Suárez-Soto A, Sánchez-Villegas A, Vicente-Barrero M. Estimation of the age of majority through radiographic evaluation of the third molar maturation degree. Med Oral Patol Oral Cir Bucal. 2020;25(3):e359-63.
54. Jeong MJ, Lee KE, Chae YK, Nam OH, Lee HS, Choi SC. Correlations between skeletal maturity and dental calcification stages in Korean children. Eur J Paediatr Dent. 2022;23(2):101-5.
55. Ramaswami TB, Rosa GC, Fernandes MM, Oliveira RN, Tinoco RLR. Third molar development by Demirjian’s stages and age estimation among Brazilians. Forensic Imaging. 2020;20:200353.
56. Bud ES, Bud A, Bică C, Stoica OE, Oltean AE, Vlasa A, et al. Evaluation of dental maturity using the Demirjian’s method in Romanian children. Acta Medica Transilvanica. 2021;26(2):48-51.
57. Galibourg A, Cussat-Blanc S, Dumoncel J, Telmon N, Monsarrat P, Maret D. Comparison of different machine learning approaches to predict dental age using Demirjian’s staging approach. Int J Legal Med. 2021;135(2):665-75.
2. Marcondes E. Idade óssea em pediatria. Pediat. 1980;2:297-311.
3. Haiter Neto F. Análise comparativa manual e computadorizada da estimativa da idade óssea pelo índice de Eklöf & Ringertz [tese]. Bauru: Universidade de São Paulo; 1995.
4. Chertkow S, Fatti P. The relationship between tooth mineralization and early radiographic evidence of ulnar sesamoid. Angle Orthod. 1979;49(4):282-8.
5. Rodriguez CYA, Arriola-Guillen LE, Flores-Mir C. Björk-Jarabak cephalometric analysis on CBCT synthesized cephalograms with different dentofacial sagittal skeletal patterns. Dental Press J Orthod. 2014;19(6):46-53.
6. Moraes MEL, Médici Filho E, Moraes LC. Surto de crescimento puberal. Relação entre mineralização dentária, idade cronológica, idade dentária e idade óssea – método radiográfico. Rev Odontol UNESP. 1998;27(1):111-29.
7. Greulich WW, Pyle SI. Radiographic atlas of skeletal development of the hand and wrist. 2a ed. Stanford: Stanford University Press; 1959.
8. Lamparski DC. Skeletal age assessment utilizing cervical vertebrae [dissertação]. Pittsburgh: University of Pittsburgh; 1972.
9. Hassel B, Farman AG. Skeletal maturation evaluation using cervical vertebrae. Am J Orthod Dentofacial Orthop. 1995;107(1):58-66.
10. Baccetti T, Franchi L, McNamara JA Jr. An improved version of cervical vertebral maturation (CVM) method for the assessment of mandibular growth. Angle Orthod. 2002;72(4):316-23.
11. Bassed RB, Briggs C, Drummer OH. Analysis of time of closure of the spheno-occipital synchondrosis using computed tomography. Forensic Sci Int. 2010;200(1-3):161-4.
12. Angelieri F, Cevidanes LH, Franchi L, Gonçalves JR, Benavides E, McNamara JA Jr. Midpalatal suture maturation: classification method for individual assessment before rapid maxillary expansion. Am J Orthod Dentofacial Orthop. 2013;144(5):759-69.
13. Nolla CM. The development of permanent teeth. J Dent Child. 1960;27(4):254-66.
14. Demirjian A, Goldstein H, Tanner JM. A new system of dental age assessment. Hum Biol. 1973;45(2):211-27.
15. Garn SM, Rohmann CG. Variability in the order ossification of the bony centers of the hand and wrist. Am J Phys Anthropol. 1960;18(3):219-30.
16. Guzzi BSS, Carvalho LS. Estudo da maturação óssea em pacientes jovens de ambos os sexos através de radiografias de mão e punho. Ortodontia. 2000;33(3):49-58.
17. Koc A, Karaoglanoglu M, Erdogan M, Kosecik M, Cesur Y. Assessment of bone ages: is the Greulich-Pyle method sufficient for Turkish boys? Pediatr Int. 2001;43(6):662-5.
18. Breen AB, Steen H, Pripp A, Hvid I, Horn J. Comparison of different bone age methods and chronological age in prediction of remaining growth around the knee. J Pediatr Orthop. 2023;43(6):386-91.
19. Yeong-Senga Y, Ting Ywan C, Jeffrey CC. Applicability of the Greulich and Pyle bone age standards to Taiwanese children: a Taipei experience. J Chin Med Assoc. 2022;85(7):767-73.
20. Yeong-Senga Y, Ting Ywan C, Tao-Hsine T. Bone age assessment: large-scale comparison of Greulich-Pyle method and Tanner-Whitehouse 3 method for Taiwanese children. J Chin Med Assoc. 2023;86(2):246-53.
21. Wang YM, Tsai TH, Hsu JS, Chao MF, Wang YT, Jaw TS. Automatic assessment of bone age in Taiwanese children: a comparison of the Greulich and Pyle method and the Tanner and Whitehouse 3 method. Kaohsiung J Med Sci. 2020;36(11):937-43.
22. Faustino-da-Silva YV, Martinho DV, Coelho-E-Silva MJ, Valente-Dos-Santos J, Conde J, Oliveira TG, et al. Reproducibility and inter-observer agreement of Greulich-Pyle protocol to estimate skeletal age among female adolescent soccer players. BMC Pediatr. 2020;20(1):494.
23. Koc U, Taydaş O, Bolu S, Elhan AH, Karakas SP. The Greulich-Pyle and Gilsanz-Ratib atlas method versus automated estimation tool for bone age: a multi-observer agreement study. Jpn J Radiol. 2021;39(3):267-72.
24. Booz C, Yel I, Wichmann JL, Boettger S, Kamali AA, Albrecht MH, et al. Artificial intelligence in bone age assessment: accuracy and efficiency of a novel fully automated algorithm compared to the Greulich-Pyle method. Eur Radiol Exp. 2020;4(1):6
25. Fishman LS. Can cephalometric x-rays of the cervical column be used instead of hand-wrist x-rays to determine patient's maturational age? Am J Orthod Dentofacial Orthop. 2022;122(1):18A-19A.
26. García-Fernandez P, Torre H, Flores L, Rea J. The cervical vertebrae as maturational indicators. J Clin Orthod. 1998;32(4):221-5.
27. Flores-Mir C, Burgess CA, Champney M, Jensen RJ, Pitcher MR, Major PW. Correlation of skeletal maturation stages determined by cervical vertebrae and hand-wrist evaluations. Angle Orthod. 2006;76(1):1-5.
28. Gandini P, Mancini M, Andreani F. A comparison of hand-wrist bone and cervical vertebral analyses in measuring skeletal maturation. Angle Orthod. 2006;76(6):984-9.
29. Damian MF, Woitchunas FE, Cericato GO, Cechinato F, Moro G, Massochin ME, et al. Análise da confiabilidade e da correlação de dois índices de estimativa da maturação esquelética: índice carpal e índice vertebral. Rev Dent Press Ortodon Ortop. 2006;11(5):110-20.
30. Uysal T, Ramoglu SI, Basciftci FA, Sari Z. Chronologic age and skeletal maturation of the cervical vertebrae and hand-wrist: Is there a relationship? Am J Orthod Dentofacial Orthop. 2006;130(5):622-8.
31. Caldas MP, Ambrosano GMB, Haiter-Neto F. Computer assisted analysis of cervical vertebral bone age using cephalometric radiographs in Brazilian subjects. Braz Oral Res. 2010;24(1):120-6.
32. Al Khal HA, Wong RWK, Rabie ABM. Elimination of hand-wrist radiographs for maturity assessment in children needing orthodontic therapy. Skeletal Radiol. 2008;37(3):195-200.
33. Gabriel DB, Southard KA, Qian F, Marshall SD, Franciscus RG, Southard TE. Cervical vertebrae maturation method: poor reproducibility. Am J Orthod Dentofacial Orthop. 2009;136(4):478.e1-7; discussion 478-80.
34. Baccetti T, Franchi L, McNamara JA Jr. The cervical vertebral maturation (CVM) method for the assessment of optimal treatment timing in dentofacial orthopedics. Semin Orthod. 2005;11(3):119-29.
35. Carelli J, Madalena IR, Mattos C, Morais ND, Lopes, CMCF, Scariot, R, et al. Avaliação da correlação entre maturação esquelética e maturação dentária em crianças brasileiras. RSBO. 2020;17(2):162-71.
36. Alqadi MA, Abuaffan AH. The reliability of Fishman and Nolla methods in prediction of chronological age of Yemeni children. Braz Dent Sci. 2020;23(3):1-9.
37. Magat G, Ozcan S. Assessment of maturation stages and the accuracy of age estimation methods in a Turkish population: a comparative study. Imaging Sci Dent. 2022;52(1):83-91.
38. Amasya H, Yildirim D, Aydogan T, Kemaloglu N, Orhan K. Cervical vertebral maturation assessment on lateral cephalometric radiographs using artificial intelligence: comparison of machine learning classifier models. Dentomaxillofac Radiol. 2020;49(5):20190441.
39. Scheuer L, Black S. Developmental juvenile osteology. San Diego: Elsevier Academic Press; 2000.
40. Ennes J, Consolaro A. Sutura palatina mediana: avaliação do grau de ossificação em crânios humanos. Rev Dent Press Ortodon Ortop Facial. 2004;9(5):64-73.
41. Silva C, Goldberg T, Teixeira A, Dalmas J. Mineralização óssea em adolescente do sexo masculino: anos críticos para a aquisição da massa óssea. J Pediatr. 2004;80(6):461-7.
42. Marshall D. Radiographic correlation of hand, wrist, and tooth development. Dental Radiog Photogr. 1976;49(3):51-72.
43. Ferreira ER Jr, Pinto LAMS, Pinto RS. Estágio de mineralização dental: 1. análise comparativa entre os sexos. Rev Odontol UNESP. 1993;22(2):303-13.
44. Bolaños MV, Manrique MC, Bolaños MJ, Briones MT. Approaches to chronological age assessment based on dental calcification. Forensic Sci Int. 2000;110(2):97-106.
45. Rossi RR, Amorim SG, Pacheco MCT. Correlação entre estágios de mineralização dos dentes e estimativa da maturação esquelética. Ortodontia. 1999;32(3):48-58.
46. Chhaparwal Y, Kumar M, Madi M, Chhaparwal S, Pentapati KC. Age estimation by modified Demirjian’s method in a hospital-based population: a radiographic study. Pesqui Bras Odontopediatria Clín Integr. 2021;21:e0137.
47. Han MQ, Jia SX, Wang CX, Chu G, Chen T, Zhou H, et al. Accuracy of the Demirjian, Willems and Nolla methods for dental age estimation in a northern Chinese population. Arch Oral Biol. 2020;118:104875.
48. Gonçalves LS, Machado ALR, Gaêta-Araujo H, Recalde TSF, Oliveira-Santos C, Silva RHA. A comparison of Demirjian and Willems age estimation methods in a sample of Brazilian non-adult individuals. Forensic Imaging. 2021;25:20045.
49. Barati S, Khafri S, Rahmati Kamel M, Sheikhzade S, Abesi F, et al. Comparison of Demirjian and Willems methods in estimating dental age and modification of Willems method for 7 - 15 year olds Iranian population. Iran J Pediatr. 2022;32(5):e122126.
50. Mónico LS, Tomás LF, Tomás I, Varela-Patiño P, Martin-Biedma B. Adapting Demirjian standards for Portuguese and Spanish children and adolescents. Int J Environ Res Public Health. 2022;19(19):12706.
51. Filipović G, Djordjević NS, Stojanović NM, Brkić Z, Igić M, Marjanović D, et al. Evaluation of chronological age based on third-molar development in the Serbian population. Vojnosanit Pregl. 2020;77(10):1054-9.
52. Yassin SM, Al Almai BAM, Ali Huaylah SH, Althobati MK, AlHamdi FMA, Togoo RA. Accuracy of estimating chronological age from Nolla’s Method of dental age estimation in a population of Southern Saudi Arabian children. Niger J Clin Pract. 2020;23(12):1753-8.
53. Marrero-Ramos MD, López-Urquía L, Suárez-Soto A, Sánchez-Villegas A, Vicente-Barrero M. Estimation of the age of majority through radiographic evaluation of the third molar maturation degree. Med Oral Patol Oral Cir Bucal. 2020;25(3):e359-63.
54. Jeong MJ, Lee KE, Chae YK, Nam OH, Lee HS, Choi SC. Correlations between skeletal maturity and dental calcification stages in Korean children. Eur J Paediatr Dent. 2022;23(2):101-5.
55. Ramaswami TB, Rosa GC, Fernandes MM, Oliveira RN, Tinoco RLR. Third molar development by Demirjian’s stages and age estimation among Brazilians. Forensic Imaging. 2020;20:200353.
56. Bud ES, Bud A, Bică C, Stoica OE, Oltean AE, Vlasa A, et al. Evaluation of dental maturity using the Demirjian’s method in Romanian children. Acta Medica Transilvanica. 2021;26(2):48-51.
57. Galibourg A, Cussat-Blanc S, Dumoncel J, Telmon N, Monsarrat P, Maret D. Comparison of different machine learning approaches to predict dental age using Demirjian’s staging approach. Int J Legal Med. 2021;135(2):665-75.