Original Article

Age Estimation using Cameriere’s Seven Teeth Method with

Indian Specific Formula in South Indian Children
Tapaswini Bagh1, Laxmikanth Chatra2, Prashanth Shenai3, Veena KM4, Prasanna Kumar Rao5,
Rachana V Prabhu6, Tashika Kushraj7, Prathima Shetthy8
1
Postgraduate Student, 2Professor and Head, 3Professor, 4Associate Professor, 5,7,8Reader, 6Senior Lecturer
Department of Oral Medicine and Radiology, Yenepoya Dental College, Yenepoya University, Mangalore, Karnataka,
India.

Corresponding Author: Prof (Dr.) Laxmikanth Chatra, Department of Oral Medicine and Radiology, Yenepoya
Dental College, Yenepoya University, Deralakatte, Mangalore, Karnataka, India. Email id: [email protected]

Abstract
Introduction: Teeth formation is widely used to assess maturity and predict age. This information aids in
diagnosis and treatment planning in clinical as well as in forensic dentistry. Dental age estimation is based on
morphological, histological, biochemical and radiological assessment of teeth. Radiographic age estimation
using teeth rely on developmental stages of teeth especially in children .This makes utilization of radiographic
methods for age estimation a practical method especially in living individuals as it is a simple, nondestructive
and a reliable method. Moreover, it can also be used in dead persons as well as in skeletal remains.
Aim: To evaluate an Indian sample by means of modified Cameriere’s European Formula and to correlate the
efficacy of chronological and dental age by using this formula. An attempt was made to estimate the
chronologic age of an individual by using dental radiograph in Mangalorian children.
Materials and Method: The present study comprised of 25 subjects ranging from 5-15 years. Dental age was
assessed by using Cameriere method based on 7 permanent left mandibular teeth. Panoramic radiographs
were taken for the measurement of open apices of individual tooth root. Data were analyzed by using Student’s
t-test.
Results: The mean chronological age of our sample were 9.83 ± 2.83years and by Cameriere method
9.88 ± 2.15 years, showed no statically difference between the two methods. For the Intra class correlation
coefficient showed (ICC = 0.971) excellent agreement between Chronological age and ages estimated by
Cameriere method.
Conclusion: The present study indicated that, Cameriere method was reliable for age estimation in our
sample. Age of subjects can therefore be estimated with a good degree of accuracy using this specific formula.
Keywords: Cameriere et al. Regression Equation, Dental Age, Forensic Dentistry, Panoramic Radiograph

Introduction: responsibility such as rape, kidnapping, employment,

In humans age determination is done for various marriage, premature births, adoption, illegal
reasons. Age determination of cadavers is carried out immigration, paediatric endocrinopathy, orthodontic
in victims of mass disasters such as fires, crashes, malocclusion and when the birth certificate is not
accidents, homicides, feticides and infanticides etc. In available and records are suspect for reasons such as
living person, the age estimation is done to assess criminal cases. The present study deals with the dental
whether the child has attained the age of criminal implications in human age determination using
radiological methods.

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Age Estimation by Cameriere Method Original Article
Dental age is one of the few measures of history, previously orthodontic treatment, evident
physiologic development that is uniformly systemic diseases and congenital anomalies,
applicable from infancy to late adolescence. After premature birth, hypodontia of permanent teeth
attaining maturity, teeth continue to undergo changes; except third molars and hyperdontia. Patients were
making age estimation possible in adults.3 The study subjected to panoramic radiograph (Planmeca
of morphological parameters of teeth on dental proMax) by using PSP plates as image receptor
radiograph of children is more reliable than other system, these PSP plates were later digitized in Agfa
methods for age estimation. The most common laser scanner (CR30-X) and images were recorded by
method for age estimation was published in 1973 by Computerized-aided drafting program system. Then
Demirjian, Goldstein and Tanner, and subsequently the measurements of individual tooth-root ratio (A/L)
modified by other authors.4 A common finding is that were linearly desired using agfa-nx software.
Demirjian overestimated age although an Mandibular left teeth were examined and Cameriere
underestimation has also been reported. method was applied. Age was estimated, which was
To improve the method, several authors have then compared with the chronological age.
developed alternative approaches based on the (Chronological age= date of radiograph taken – date
measurement of some significant tooth parameters, of birth).
such as the degree of racemization of aspartic acid in
tooth enamel.5, 6, 7 Crown height, apex width root and Dental age estimation:
pulp length 8 of teeth observed in radiographs. A new Dental age estimation was done by using
method was published by Cameriere involving Cameriere’s Regression formula: Age = 9.402-
measurement of open apices of left mandibular 0.879c+0.663No-0.711s-0.106sNo, C = variable boys
permanent teeth .9,13 The aim of the present study was (1) and girls (0) Where No: teeth with apical ends of
to assess the dental age of Indian children using the roots completely closed. s: sum of A/L ratio for
Cameriere method and to check its efficacy in south every tooth at open apex.Ai: radiographic distance
Indian children. between inner sides of the open apex. Li: radiographic
tooth length. (Li, i= 1… 7). An example of tooth
Materials and Methods: measurement. Ai, i = 1. . . 5 (teeth with one root), is
Before starting the study, the synopsis of the study distance between inner sides of open apex; Ai, i = 6
was presented in front of the ethical committee of and 7 (teeth with two roots: A7 is the sum of the
Dental College, Yenepoya University and the distances (A7=A7a+A7b) between inner sides of the
clearance was taken from the ethical committee two open apices, and L7 is the length of second molar)
before starting the study. and Li, i = 1. . . 7, is length of seven teeth and N0 =
The present study included 25 patients tooth with a closed root: A6. Once the measurements
(11females, 14 males) with age group between 5-15 were recorded in digital panoramic radiograph, it is
years [Table-1] who were advised for panoramic calculated by dividing magnification factor 1.2, which
radiograph selected by using simple random sampling was applied in Cameriere’s Indian formula. Dental
technique for the study. Nature of the study was maturity was evaluated with the normalized
explained to the patients and written consent was measurements of the 7 left permanent mandibular
taken from the participants. Brief clinical findings teeth. (xi= Ai/Li, i = 1……7), the sum of the
along with personal details of the patient were normalized open apices (s =
13
recorded using a standard format. The inclusion x1+x2+x3+x4+x5+x6+x7)[Figure 1]
criteria were age between 5 to 15 years at the time of An Example of a Panoramic radiograph (male) of
panoramic radiographs were obtained, good quality our study group: Chronological age was 8.7y and by
radiographs, no agenesis or extractions in the left Cameriere Method: [N0: total no of teeth with apical
lower quadrant and teeth in their developmental path. ends of the roots completely closed; (central incisor,
Exclusion criteria were incomplete dental or medical lateral incisor and first molar) 31,32, 36 = 3, the length

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Age Estimation by Cameriere Method Original Article
of the teeth to size of open apex of canine, first = 9.402 – 0.879×1 + 0.663×3 –
premolar, second premolar and second molar were 0.711×2.17 – 0.106×2.17×3
measured;x3= A3 /L3( 0.41/1.70 with dividing by = 6.53 + 2.23 = 8.76 y]
Magnification factor: 1.2 =0.24),x4= A4/L4(0.43/1.30
=0.33, x5 = A5/L5( 0.76/1.02 = 0.74), x7 Statistical analysis and data management:
=A7/L7(0.82/0.95 = 0.86), s Statistical analysis was performed with SPSS
=X3+X4+X5+X7 = 0.24 + 0.33 + 0.74 + 0.86 = 2.17. version 18.0 statistical program. Student’s t-test was
[Figure no. 2 & 3]. used to compare the morphological variables of males
with those of females and to compare observed age
Dental age = 9.402 – 0.879c + 0.663N0 – 0.711s – with estimated age.
0.106sN0

Table No. 1: Cross Tabulation between Age and Sex Group

Age groups Sex Total
Females Males
5-7 y 2 (8%) 3 (12%) 5 (20%)
8-9 y 3 (12%) 4 (16%) 7 (28%)
10-11 y 4 (16%) 5 (20%) 9 (36%)

12-13 y 1 (4%) 2 (8%) 3 (12%)

14-15 y 1 (4%) 0 (0%) 1 (4%)
Total 11 ( 44% ) 14 (56 %) 25 (100%)

Figure No. 1: An Example of Tooth Measurement from Mandibular Left Permanent

Canine to Second Molar

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Age Estimation by Cameriere Method Original Article

Figure No. 2 & 3: An Example of a Panoramic Radiograph from our Study Group
(Male) Before and after Measurement of Teeth

Figure No. 2 Figure No. 3

Results: Our method, based on the normalized open apices of

Results of the present study showed, age of the the seven permanent left mandibular teeth, employed
collected sample size 25 out of which 11female (44%) a second-degree polynomial function [Model
and 14 male (56%) ranges between 5-7y( 20%),8- summary]
9y(28%),10-11y(36%),12-13y(12%),14-15y(4%)
[Table -1]. Comparision between ages estimated by Discussion:
Cameriere’s method and Chronological age in total The aim of the present study is to estimate
study group [Table-2]. On an average chronological chronological and dental age in individuals from
age was 9.83 ± 2.38 y and by Cameriere method Mangalore between 5-15 years of age. The age range
9.88 ± 2.15 y, showed no statistical difference from 5-15 years remains the most critical with regard
between the two methods as p = 0.728 (p<0.05 for to estimating a child’s dental age and consequently to
significance). For Intraclass correlation coefficient determine the proper timing for orthodontic therapy.
showed (ICC = 0.971) excellent agreement between This age group is commonly accepted for dental age
the two methods [Table-3 & Graph-1].Analyses were estimation in children as teeth development passes
performed among the males and females through various stages during this age group. Teeth
separately,showed no significant difference between development depends upon number of factors such as
Chronological age and Cameriere method (p > genetic factor, environmental factors, nutritional
0.05).For Intraclass correlation coefficient was above factors and geographical factors. Tooth eruption is
0.959 for both males and females, showed no gender influenced by other factors also such as space in the
influence on the level of agreement between the two dental arch, extraction of deciduous predecessors
methods.Finally an attempt was made to establish tipping or impaction of teeth. During developmental
Regression equation to estimate the actual age by stages particularly in root formation, a notable
finding out age by Cameriere Method. The equation difference between sexes arises with females being
is: Chronological age = -1.137 + 1.078*Age by advanced when compared with males. Hence the
Cameriere method + 0.554* Gender (Gender: Male dental age estimation using developmental stages of
substitute as 1, for female substitute as 0) [Table- 4 & teeth in this age group is acceptable as it is less
5] Model-1 explained 91.0% of variance (R2 = 0.910). influenced by environmental factors.

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Age Estimation by Cameriere Method Original Article

Table No. 2: Comparison between Ages Estimated by Cameriere's Method and

Chronological Age in Total Sample

S. No. Gender Age By Cameriere Method Chronological Age ( In Years )

1 Male 10.83333 11.14

2 Male 9.416667 8.29
3 Male 7.5 7.14
4 Male 9.416667 8.14
5 Male 11.66667 11.07
6 Male 11.16667 10.79
7 Male 8.583333 8.36
8 Male 10.33333 10.07
9 Male 15.66667 16
10 Male 12.33333 12.07
11 Male 7.833333 8.14
12 Male 11.5 11.21
13 Male 7.833333 7.21
14 Male 8.166667 10.07
15 Female 12.33333 13.07
16 Female 8.5 8.36
17 Female 9.25 9.07
18 Female 6.083333 5.07
19 Female 8.666667 8.57
20 Female 11.58333 11.43
21 Female 11.33333 11.21
22 Female 7.833333 7.29
23 Female 8.25 10.07

24 Female 8.583333 8.5

25 Female 12.33333 13.29

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Age Estimation by Cameriere Method Original Article

Table No. 3: Mean and Standard Deviation of Chronological Age (In Years) and Ages
Estimated by Cameriere Method in Total Study Group. Intraclass Correlation
Coefficient: Icc between Chronological Age and Cameriere Method
Methods N Min. Max. Mean Std. Diff t P
deviation value value
Chronological 25 9.83 5.07 16.00 9.83 2.38
age Range ± 2.83
Mean
±SD .05 0.352 0.728
Dental age Range 25 9.88 6.08 15.67 9.88 2.15
(Cameriere mean± ± 2.15 NS
method ) SD

ICC: Intraclass Correlation

Intraclass 95% confidence interval P value
Correlation
Low Bound Upper
bound
0.935 0.987 0.000 HS

*
HS=highly significant

Graph No. 1: Correlation between Ages Estimated by Cameriere's Method and

Chronological Age in Total Sample. (P=0.000)
18
16
Chronological age(years)

14
12
10
8
6
4
2
0
0 5 10 15 20
Age by Cameriere Method

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Age Estimation by Cameriere Method Original Article

Table No. 4: Mean and Standard Deviation of Chronological Age and Ages Estimated by
Cameriere Method in Both Males and Females Group Separately
Gender N Minimum Maximum Mean Std. Diff. t value p
Deviation value
Females 0.075
Chronological 11 7.14 16.00 10.11 2.53
age 0.32 1.985
Cameriere 11 7.50 15.67 10.43 2.33 NS
Method
Males
Chronological 14 5.07 13.29 9.60 2.33
age 0.16 0.665 0.517
Cameriere 14 6.08 12.33 9.45 1.98
Method NS

*
NS: Not significant
Interpretation of ICC
< 0.40 Poor agreement
.4 -- .75 Fair agreement
.75 -- .85 Good agreement
> 0.85 Excellent agreement

Table No. 5: Regression Analysis with Selected Morphological Variables (Predictors)

and Age as the Dependent Variable in the Total Study Sample
Unstandardized Standardized Significance
Model Coefficients Coefficients
B Std. error Beta t value p value
1 Constant - 1.137 0.791 - 1.438 0.164
Cameriere Method 1.078 0.073 0.975 14.837 0.000
Gender 0.554 0.308 0.118 1.797 0.086

a
dependent Variable: Chronological age
a.
Predictors: Constant, gender, cameriere

Model summary
Model R R2
a
1 0.954 0.910

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Age Estimation by Cameriere Method Original Article
Present study is a Cross-sectional study taking a correlation coefficient was 0.89 between two
sample of 25 subjects with distribution between male observers rating. 14 In present study the intraclass
and female. The radiological method is among one of correlation coefficient showed excellent agreement
the most reliable method available for age estimation (ICC= > 0.85).
which is widely used for both dental and skeletal Another study was conducted by Cameriere, L et
method.11,12,15 In our study dental age has been al to determine the accuracy of the Cameriere method
assessed by using Panoramic radiograph, following for assessing chronological age in children based on
the method described by Cameriere, which is widely the relationship between age and measurement of
accepted and has been studied extensively on various open apices in teeth and to compare with widely used
population by many aurthors.9,13 Demirjian and Willems method.16 In Cameriere
A study was done by Cameriere L et al on Italian method, the difference between two mean prediction
population of children aged between 5-15 years. errors was not statistically significant. Demirjian
Study based on seven mandibular left healthy method was significantly less accurate (p = 0.024).
permanent teeth for assessing dental age by Willems method was better than that of Demirjian but
measurement of open apices in teeth. Statistical was significantly less accurate than that of Cameriere
analysis showed a significant correlation with (p < 0.001). However in present sample Cameriere
chronological age, morphological variables explain method showed highly significant (p = 0.000).
83.6% (R2=0.836).9 In our study, statistical analysis A study was done by Marques MF et al showed
indicated that gender does not have a significant the great accuracy of Cameriere method in a Brazilian
influence on age estimation. (R2= 0.910). sample of 160 children aged between 5 and 15 years.
The same author Cameriere L et al was done a The results showed with a median residual errors were
study in a large sample of children from various 0.014 years (p = 0.603).17 In the present sample
European states, providing a common formula. The showed highly significant (p value = 0.000).
results showed that the median of the absolute value A study was conducted in Haryana sub-population
of residual errors were 0.035 years.10 In our study by the same author Kaur J et al Panoramic radiographs
results showed that the median residual errors were of healthy children aged between 5-15 years were
0.05 years. selected and Cameriere's regression equation was
Another study was carried out by Rai B et al on a applied. Authors observed underestimation of age in
large sample of Indian children aged between 4- boys and overestimation in girls as compared to their
16years. Results showed correlation coefficient chronological age.18 But in present study showed,
between dental age and chronological ages were gender does not have a significant influence on age
highly significant.11 The present study showed the estimation.
accuracy of Cameriere method and it’s not influenced
by any factors. Conclusion:
A study was done by Rai B et al on a large sample In the present study we found a very good
of Indian children aged between 3-15 years by correlation between the Chronologic and dental age.
applying modified Cameriere’s European formula. Results indicated the suitability of the sum of
Results showed a significant correlation with normalized open apices (s) and number (N0) of teeth
chronological age except gender and second with complete root development as developmental
premolar, these morphological variables explain 89.7 markers. We have also come up with a linear
%( R2= 0.897) variations in estimated dental age.13 regression equation for both males and females which
The present study showed gender does not have a can be used in order to decrease the gap between the
significant influence on age estimation. (R2= 0.910). Chronologic age and dental age, so that a relative
A study was done by Kaur J et al on Haryana approximate age can be obtained. Since our study has
population aged between 5-15 years and applied a small sample size we were not able to give the exact
Cameriere’s regression equation. The concordance value of variation between each age group that the

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Age Estimation by Cameriere Method Original Article
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How to Cite: Bagh T, Chatra L, Shenai P, Veena KM, Rao PK, Prabhu RV, Kushraj T, Shetthy P. Age Estimation
using Cameriere’s Seven Teeth Method with Indian Specific Formula in South Indian Children. Int J Adv Health Sci
2014; 1(2): 2-10

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