ORIGINAL RESEARCH

Journal of Dentomaxillofacial Science (J Dentomaxillofac Sci ) August 2016, Volume 1, Number 2: 103-108
P-ISSN.2503-0817, E-ISSN.2503-0825

Differences between chronological age and dental

age using Demirjian’s method based upon a
radiology study using Dental Hospital Department CrossMark
of Panoramic Radiography Hasanuddin University.

Barunawaty Yunus,1 Yulia Wardhani2*

Abstract

Objective: This study was an observational analytic using cross- chronological age and dental age is determined using Demirjian’s
sectional study, where all data are observed once at the time. In method based on radiology analysis of panoramic radiography.
this study, the amount of sample reviewed were 30 samples, which Results: The estimating the score of dental age using Demirjian
consisted of 4–9 years old children. Panoramic radiographs were method. After that, the dental age and chronological age was analyzed
collected based on target population, which fulfilled sample criteria to obtain the mean difference. Based on Wilcoxon test, the mean value
from reconciled patient of Dental Hospital Department of Dental was obtained as p:0.011 (p<0.05), this result shows that there is
Radiology Hasanuddin University. significant difference between chronological age and dental age.
Material and Methods: The tooth eruption is estimated according Conclusion: As a conclusion the chronological age and dental age can
to Demirjian’s method by assessing growth and development process be assessed by reviewing the panoramic radiography using Demirjian’s
of tooth using panoramic radiography. The difference between method.

Keywords: Dental age, Chronological age, Demirjian’s method, Panoramic radiography

Cite this Article: Yunus B, Wardhani Y. 2016. Differences between chronological age and dental age using demirjian’s method based upon a
radiology study using panoramic radiography at the dental hospital Hasanuddin university. Journal of Dentomaxillofacial Science 1(2): 96-101.
DOI:10.15562/jdmfs.v1i2.6

1
Department of Dental Radiology, Introduction
Faculty of Dentistry, Hasanuddin
University, Makassar, Indonesia The tooth eruption is a physiological process in is still questioned because it is difficult to point out
2
Faculty of Dentistry, Hasanuddin the form of tooth movement, which starts from the exact eruption period because the event occurs
University, Makassar, Indonesia the place of tooth development inside the alveolar fast, so the marking is done clinically. Moreover, it
bone, then the tooth penetrates the gingival until it is affected by the local factors like systemic disease,
finally reached the occlusal plane.1,2 as well as eating habits. At the same time, the calcifi-
The chronological age is determined based on cation stage method is used as a more reliable crite-
the date, month and year of birth.3 In general, the rion (criteria) to determine the tooth maturation
somatic development is related with the chrono- stage. Tooth calcification method gives a very clear
logical age as in the measurement of somatic matu- description in deciding teeth maturation.7 Hence,
rity, such as the bone age, menstruation and the the dental age in this research is determine by the
body height. The somatic maturity can be used to method of tooth calcification stage.
estimate the chronological age if there is no other In this research, the Demirjian’s method is used to
accurate age information available.4,5 This infor- determine the dental age of the patients, which is the
mation is important in medical practices and for process of permanent tooth bud’s calcification. From
dentists to evaluate the development of the patient. tooth bud, there is no calcification until the final
The chronological age is frequently not enough in forming of tooth root.8 This research is done to find
marking the growth stage and somatic maturity of the difference between chronological age and dental
*
Correspondence to: Yulia Wardhani,
Faculty of Dentistry, Hasanuddin the patient, therefore determining the biological age by testing the reliability of the Demirjian’s method
University, Makassar, Indonesia age is needed.6 that analyzed teeth’s calcification stage to acquire the
[email protected] Dental age, or what they usually call the biological dental age of the patient. Therefore, the distribution
age, is the estimation of age, which is calculated based of dental age estimation using the Demirjian’s method
Received: 12 April 2016 Revised: on the growth and development of the human beings. observed using the panoramic radiography photo
15 August 2016 Accepted: 17 The dental age gives information that if the growth needs to be known, which will later be subtracted by
August 2016 Available Online: 31
August 2016
of a person has reached a certain stage.7 The tooth the chronological age to find the difference between
eruption period has some flaws where its reliability the chronological age and the dental age.

103  http://jdmfs.org
 ORIGINAL RESEARCH

Material and Methods on some specific criteria such as the assigned time
interval or sample numbers or patients.
The design used in this research is observational The data was analyzed using SPSS 18.0 (SPSS Inc,
analysis with cross-sectional design, done in Chicago, IL, USA) program. The research protocol
Dental Hospital Department of Dental Radiology was approved by the ethical committee, Faculty of
Hasanuddin University in Makassar, Indonesia on Medicine, Hasanuddin University.
1st April–31st May 2015.
Populations of research are children aged
4–9 years old, who visited Dental Hospital Results
Department of Dental Radiology Hasanuddin
The research was done on 47 patients of Dental
University. Research samples are panoramic
Hospital and Radiology Section of Oral, the place
radiography and the chronological age of the
of the research. From the data gathered from April
patients, which were obtained from the identity of
to May, some data were dropped out due to some
the patients who were referred to Department of
exclusion criteria. Therefore, the distribution was
Dental Radiology during April until May 2015. The
done on 30 subjects. Descriptions of chronological
samples were acquired by consecutive sampling
age and dental age were acquired by Demirjian’s
technique, a method of acquiring sample based
method, based on radiology study using panoramic
radiography. The research results are shown on the
distribution table 1.
Table 1 shows the characteristics of research samples distribution Table 1 shows the characteristics of samples
Sample characteristics Frequency (n) Percentage (%) Mean ± SD distribution in a total of 30 people (100%). In
Gender this research, the number of females are larger
than the number of males with 18 females (60%)
Male 12 40
and 12 males (40%). The average of chronological
Female 18 60 age reaches up to almost 7 years old or more than
Chronological age (year) 6.91 ± 1.40 6 years old, meanwhile, the average of dental age
4–5 6 20 acquired by Demirijan’s method reaches up to more
6–7 12 40 than 7 years old. Based on chronological age cate-
gory, the most number of samples was found on
8–9 12 40
6–7 years old and 8–9 years old category, each was
Dental age (year) 7.20 ± 1.26 12 samples in total (40%). Only six samples with the
4–5 7 23.3 chronological age of 4–5 years old were acquired in
6–7 14 46.7 this research. In contrast, based on the dental age,
8-9 9 30
the age 6–7 years old category has the most number
of samples, with 14 people in total (46.7%),
Total 30 100
meanwhile age 8–9 years old came second, with
nine
Table 2 Shows Demirjian’s method: observation of stages of permanent teeth sample distribution
Demirjian’s Stage Observation Results
Stage B Stage C Stage D Stage E Stage F Stage G Stage H
Permanent n (%) n (%) n (%) n (%) n (%) n (%) n (%)
Teeth
I1 0 (0%) 1 (3.3%) 2 (6.7%) 9 (30%) 4 (13.3%) 12 (40%) 2 (6.7%)
I2 0 (0%) 0 (0%) 4 (13.3%) 12 (40%) 8 (26.7%) 5 (16.7%) 1 (3.3%)
C 0 (0%) 2 (6.7%) 6 (20%) 11 (36.7%) 11 (36.7%) 0 (0%) 0 (0%)
P1 1 (3.3%) 7 (23.3%) 8 (26.7%) 12 (40%) 2 (6.7%) 0 (0%) 0 (0%)
P2 3 (10%) 6 (20%) 10 (33.3%) 8 (26.7%) 3 (10%) 0 (0%) 0 (0%)
M1 0 (0%) 0 (0%) 1 (3.3%) 8 (26.7%) 3 (10%) 15 (50%) 3 (10%)
M2 6 (20%) 6 (20%) 15 (50%) 1 (3.3%) 1 (3.3%) 0 (0%) 1 (3.3%)
Explanation:
I1 = Central incisor
I2 = Lateral incisor
C = Canine
P1 = First premolar
P2 = Second premolar
M1 = First molar
M2 = Second molar

Journal of Dentomaxillofacial Science (J Dentomaxillofac Sci ) August 2016; 1(2): 96-101 | doi: 10.15562/jdmfs.v1i2.6 104
ORIGINAL RESEARCH

Table 3 Shows chronological age and dental age average have entered in the stage H. Table 2 also shows that
(years) distribution by gender, chronological age there are 12 I2 teeth (40%), which reached stage E
category and dental age category and only one I2 tooth (3.3%) that has reached the
Chronological age Dental age
stage H. In the canine teeth, 11 teeth (36.7%) have
Characteristics of reached stage E and F but none of the teeth has
samples Mean ± SD Mean ± SD reached the stage G or H. Other observations show
Gender that 12 (40%) P1 teeth have reached the stage E but
Male 6.942 ± 1.343 7.433 ± 1.026 still there is one P1 tooth in stage B. About 10 P2
Female 6.889 ± 1.490 7.044 ± 1.407 teeth reached stage D, which is 10 P2 teeth (33.3%)
and only 3 P2 teeth reach the stage F. In addition,
Chronological age
of the 30 M1 teeth observed, three M1 teeth have
4–5 years old 4.883 ± 0.449 5.383 ± 0.591 reached stage H and still one tooth that is at the
6–7 years old 6.500 ± 0.522 7.017 ± 0.868 stage D. In contrast, in the M2 teeth, only one M2
8–9 years old 8.333 ± 0.492 8.292 ± 0.405 tooth that has reached stage H and six teeth (20%)
Dental age are at stage B.
Table 3 shows the chronological age and dental
4–5 years old 5.143 ± 0.690 5.257 ± 0.403
age average distribution in years by gender, chrono-
6–7 years old 6.807 ± 0.848 7.371 ± 0.529 logical age category and dental age category. The
8–9 years old 8.444 ± 0.527 8.444 ± 0.346 results showed that male’s chronological age and
Total 6.910 ± 1.409 7.200 ± 1.264 dental age with difference of 0.491, whereas in
women, the chronological age and dental age
differed only by 0.155. Based on chronological
Table 4 Shows chronological age and dental age category by age categories, seen in the 4–5 years old category,
gender distribution the chronological age is 4.8 years old, but the
Gender dental age reaches 5.38 years old. Meanwhile, in the
Chronological age and
dental age Male Female Total 6–7 years old category, the dental age is also higher
Chronological age than the chronological age. However, it is inversely
proportional as seen in the 8–9 years old chrono-
4–5 years old 2 (6.7%) 4 (13.3%) 6 (20%)
logical age category in which the chronological age
6–7 years old 6 (20%) 6 (20%) 12 (40%) is higher than the dental age. Based on the dental
8–9 years old 4 (13.3%) 8 (26.7%) 12 (40%) age category, as seen in the 4–5 years old dental age
Dental age category, the chronological age reaches 5.14 years
4–5 years old 1 (3.3%) 6 (20%) 7 (23.3%) old, while the dental age is only 5.25 years old. In
the 8–9 years old dental age category, the chrono-
6–7 years old 8 (26.7%) 6 (20%) 14 (46.7%)
logical age and dental age has the same average.
8–9 years old 3 (10%) 6 (20%) 9 (30%) Table 4 shows the chronological age and dental
Total 12 (40%) 18 (60%) 30 (100%) age category by gender distribution. The study
shows, at the 4–5 years old chronological age and
dental age, the number of men is more on chrono-
Table 5 Shows chronological age and dental age overall
logical age category, while the number of women is
differences
as much on the dental age category. In the 6–7 years
Chronological age Dental age old chronological and dental age category, the
n (%)
Mean ± SD Mean ± SD p–
–value number of men is more on the dental age compared
30 (100%) 6.910 ± 1.409 a
7.200 ± 1.264 0.011* to chronological age category but the number
of women on both categories is the same. As for
Note: Normality test; Shapiro–Wilk test: p > 0.05; normal data distribution. Sign Rank test:
p < 0.05.
the 8–9 years old dental and chronological age,
the number of men and women on chronological
people in total (30%). The dental age 4–5 years old age category is more than the dental age.
category has the lowest number of samples with Table 5 shows the overall differences of chrono-
seven samples in total (23.3%). logical age and dental age that were obtained from
Table 2 shows the Demirjian’s method: obser- Demirjian method. The results showed that the
vation of stages of permanent teeth sample distri- chronological age only reached 6.91 years, while
bution. The result showed from 30 I1 teeth that the dental age obtained from Demirjian method
have been examined, about 12 I1 teeth (40%) have reaches 7.2 years. Table 5 also shows the normality
reached stage G and only one I1 tooth (3.3%) that test results to determine the statistical test used in
is still in the stage C. In addition, only two teeth this study. The Shapiro –Wilk normality test results

105 Journal of Dentomaxillofacial Science (J Dentomaxillofac Sci ) August 2016; 1(2): 96-101 | doi: 10.15562/jdmfs.v1i2.6
 ORIGINAL RESEARCH

Discussion
This study was conducted to determine the
differences in chronological age and dental age and
was analyzed from the images and panoramic
radio-graphs and measured using Demirjian’s
method. The chronological age obtained from age
dentition/ tooth eruption seen by date, month and
year of birth of the patient. Dental age is obtained by
looking at the growth and development of patient’s
teeth using eight stages assigned by Demirjian’s
method.
Maturity can be determined by the stage of tooth
Figure 1 A panoramic photograph result from a 5 years old boy eruption and tooth calcification. Tooth eruption
is the process of tooth movement toward occlu-
sal plane, starting from the tooth root formation.
Time eruption is a clinical maturation index. Tooth
eruption time method has its drawbacks including:
difficult to determine the exact time of the eruption
because of the activities that take place quickly,
clinically judged and influenced by local factors,
systemic disease and diet so the reliability is ques-
tionable. While the dental calcification stage is used
as a more reliable criterion to determine the tooth
Figure 2 Sighting result of photograph maturation stage, the tooth calcification gives a very
clear picture in determining teeth maturation.15
According to Flores et al.16 tooth maturation is
expressed as dental age because it is clinically easier
to be determined. By determining the maturation
of teeth, dental calcification stage is more widely
used than tooth eruption.17 This study also used the
dental calcification stage observation that is also
used by Demirjian et al. on the observation of eight
tooth calcification stages defined in the Demirjian’s
method. To assess the process of tooth calcification,
panoramic radiographs guide can be used to evaluate
the teeth on each inspection.
Panoramic radiography is one of the
extra-oral radiographs which is often used in
dentistry to obtain a complete picture of the
whole maxillofacial.10 This study takes an x-ray
panoramic radiographs photo to analyze the dental
calcification according to the provisions laid down
Figure 3 Calcification stage according to
by the eight stages of Demirjian method, that is
Demirjian’s method
figure 5, Stage A: Occlusal point calcification, with-
showed that p>0.05 is only available on the chrono- out fusion of other calcification parts, Stage B: The
logical age group. This means only the chronological fusion of the mineralization point where the occlu-
age group data is normally distributed, while the sal surface contoured the teeth is already seen,
dental age data obtained from Demirjian’s method Stage C: Calcification of the dental crown has been
is not normal. This does not qualify the parametric completed and dentin disposition starts, Stage D:
test that requires the entire data is normally distrib- The formation of the crown has been completed,
uted, thus the non-parametric test used in this Stage E: The root length of the teeth is shorter
study is Wilcoxon Signed-Rank test. Based on the than the crown height, Stage F: The root length of
Wilcoxon test results, we found the value of p:0.011 the teeth exceeds the crown height, Stage G: The
(p<0.05), which means that there are differences in formation of the root has been completed, but the
chronological age and dental age is significant. apical foramen is still open, Stage H: Apical fora-
men was closed.9,18

Journal of Dentomaxillofacial Science (J Dentomaxillofac Sci ) August 2016; 1(2): 96-101 | doi: 10.15562/jdmfs.v1i2.6 106
ORIGINAL RESEARCH

Application Stage Demirjian’s Method 4.8 years old but the dental age reaches 5.38 years
old. Meanwhile, in the age category of 6–7 years
1. The panoramic photograph result is shown old, the dental age is also higher than
(digital). the chronological age. However, it is inversely
2. A picture sighting shows seven left mandibular proportional as seen in the chronological age
teeth starting from central incisor until the category of 8–9 years old, in which the
second molar. chronological age is higher than the dental age.
3. After having the sighting results, the devel- Based on dental age categories, seen on dental
opment stage of roots and the crowns of the age category of 4–5 years old, the chronological
seven left mandibular teeth analyzed (except the age reaches 5.14 years old, while the dental age
third molar) were observed through panoramic is only 5.25 years old. At the dental age
radiography and classified according to the category of 8–9 years old, we can see the same
valuation parameter of calcification stage of average of chronological age and dental age
teeth by Demirjian’s method. table 3. A big marginal difference between
4. Each calcification stage has a score that has the chronological age and dental age are due
been determined. Scores are differentiated by to several factors that were described in
gender. the research by Willems et al.19 in Iran.
5. After the classification and scoring of each According to this research it is shown that the
tooth is completed, then all the scores of the dental age is higher than the chronological age
roots and crowns development stage of central of the patient, or vice versa due to several
incisor, lateral incisor, canine, first and second factors: ethnic variations, genetic and
premolars, first and second molar that have environmental factors: such as socioeconomic
been determined by Demirjian et al. are added. status, nutrition and lifestyle.
6. The addition results of seven teeth scores are Cheraskin et al.5 found that the chronological
then converted into a conversion of teeth age and dental age showed not only a significant
maturity table that have been set by Demirjian’s relationship between men and women but also
method to determine the patient dental age that the maturity of the teeth can be used as an
table 6. indicator to determine the chronological age.
Based on the research results, the normality test
Based on the study results, after the sighting and results showed that the data is normally distributed
adding the scores and determining the dental age of in the chronological age group only, while the dental
the entire sample, it was found that the chrono- age group data were not normally distributed. This
logical age and the dental age of the man has a proves that the results of this study were based on
difference of 0.491, whereas in women, the chrono- Wilcoxon test with a value of p:0.011 (p<0.05),
logical age and dental age only differed by 0.155. which means that there are significant differences
Based on chronological age categories, seen in the in chronological age and dental age.
age category of 4–5 years old, the chronological age
reaches
Conclusion
Table 6 Shows teeth maturity to determine patient dental age
The difference of chronological age and dental
Teeth Stage Score
age in each population were different, the dental
2nd Molar B 3.5 age have a big margin than the chronological age,
1st Molar D 8.0 the chronological age have a big margin than the
2nd Premolar B 3.1 dental age and also the average of the chronological
age and dental age were equal. Based on the research
1st Premolar C 3.4
results it can be concluded that there are significant
Canine D 3.5 differences in chronological age and dental age.
Lateral Incisor E 5.2 As a suggestion in doing panoramic radiogra-
Central Incisor E 1.9 phy techniques, an operator must really master
Total score 28.5
photo techniques and ways to approach pediatric
patients who sometimes are not cooperative and
Dental age 5.4 years
lastly a dentist is expected to understand and apply
Chronological age 5.0 years the Demirjian’s method to determine the patient’s
dental age before determining a treatment plan.

107 Journal of Dentomaxillofacial Science (J Dentomaxillofac Sci ) August 2016; 1(2): 96-101 | doi: 10.15562/jdmfs.v1i2.6
 ORIGINAL RESEARCH

Conflict of Interest 12. Tamba S. Waktu erupsi gigi permanen ditinjau dari usia
kronologis pada anak usia 6 sampai 12 tahun di SD ST
The authors report no conflict of interest. Antonius V Medan. FKG USU; 2010. p. 46–50.
13. Chiego DJ. Oral histology. Available at http://crse.dent.
umich.edu. 2006.
14. Kurita LM, Menezes AV, Casanova MS, et al. Dental
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Journal of Dentomaxillofacial Science (J Dentomaxillofac Sci ) August 2016; 1(2): 96-101 | doi: 10.15562/jdmfs.v1i2.6 108