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International Journal of Medical Research & Health Sciences ESTIMATION OF DENTAL AGE BY NOLLA'S METHOD USING ORTHOPANTOMOGRAPHS AMONG RURAL FREE RESIDENTIAL SCHOOL CHILDREN

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International Journal of Medical Research & Health Sciences ESTIMATION OF DENTAL AGE BY NOLLA'S METHOD USING ORTHOPANTOMOGRAPHS AMONG RURAL FREE RESIDENTIAL SCHOOL CHILDREN
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  273 Nandlaletal.,Int J Med Res Health Sci. 2014;3(2):273-277 International Journal of Medical Research&Health Sciences www.ijmrhs.comVolume 3 Issue 2 (April-Jun)Coden: IJMRHSCopyright @2014ISSN: 2319-5886 Received: 25 th Dec 2013 Revised: 28 th Jan 2014 Accepted: 31 st Jan 2014 Research Article ESTIMATION OF DENTAL AGE BY NOLLA’S METHOD USINGORTHOPANTOMOGRAPHSAMONG RURALFREE RESIDENTIALSCHOOL CHILDREN Nandlal B 1 , Karthikeya Patil 2 ,*Ravi.S 31 Principal &Professor in Pedodontics and PreventiveDentistry,JSS Dental College and Hospital,Mysore,Karnataka, India 2 Professor &HeadDept. of Oral Medicine & Radiology,JSS Dental College and Hospital, Mysore, Karnataka,India 3 Associate Professor, Dept of Orthodontics,JSS Dental College and Hospital, Mysore, Karnataka, India*Corresponding author email : raviortho11@gmail.com ABSTRACTIntroduction: Teeth and dental restorations are resistant to destruction by fire and the elements are thereforeuseful in identification. This permits accurate identification ofa missing childor remains. The Rural Residentialfree school at Suttur houses a large number of inmates and hence dental records are kept for theiridentification. Objective: Estimation of Ageofchildren .Methods: Orthopantomographs were usedtostudy for estimation of age of children, usinga  Nolla’s method of dental age estimation. Results: In this study Nolla’s method underestimated the chronological age of the individuals and underestimation of age increased as the chronologicalage of the individuals increased. Conclusion: Studies involving larger samplesize and population specific dataneeds to be developed. Keywords: Age Estimation by teeth, Forensic Dentistry,  Nolla’s Method, Orthopantomographs. INTRODUCTION Age estimation is usefulin general dentistry andinforensic dentistry.There are many methods of ageestimation which are tried and tested.Dental ageestimation in living individuals is done mainly bynon-invasivemethods such as general physicalexamination, intraoral examination and a panoramicradiograph. 1-3 The sequence of development of dentition can beused inthe determinationof age in situations such asattainment ofmaturity,criminal responsibility,consentetc.in living individuals.Teeth are non-destructible and havethe least turnoverof itsstructure, hence provide a vital clue for identificationof individuals in forensicOdontology. 4,5 Nolla devised a system of dental age assessmentusing radiological appearancesof maxillary teeth andmandibular teeth. The present study was aimed atestimation ofthe age of the children using Nolla’s Method of Dental Age Estimation.This study was conducted ina rural residential schoolat Suttur, where all the inmates are provided a similarnutrition and they shared same environment andphysical activities, hence an ideal place to do such astudy. METHODOLOGY The present study was conducted at JSS free ruralresidential school of Suttur, a village in southern DOI: 10.5958/j.2319-5886.3.2.059  274 Nandlaletal.,Int J Med Res Health Sci. 2014;3(2):273-277India. It houses3927 children studying from primaryto high school. 2801 children are free hostel childrenand 1126 children are day scholars,for the presentstudy weincludedonly free hostel children.Purposive sampling was used to select children forthis study.Ethical clearance was obtained fromthe InstitutionalEthical Review Boardprior to conducting the study.The selected subjects were explained in detail aboutthe procedures and a written informed consent wasobtained from parents/guardians to be a part of thestudy. The data used in the study is, one year resultsof a part of the longitudinal study being conducted atJSS Dental College. The date on which theorthopantomograph was taken and the Date of birthprovided in school records was used for calculation of the chronological ageof each subject. Calcification of permanent dentition was seen on theorthopantomograph and dental age was calculated according to Nolla’s method. Selection of sample: List of all the students of 7 yearsand 11 years was made from school records. Thosechildren who met the exclusion criteria as set wereexcluded and met the inclusion criteria were selectedfor the study.Inclusion Criteria:1.Younger children in the ageof 6½to 7½years andOlder children in the ageof10½to 11½years of age.2.Children who are inmates of residential school of Suttur.3.Children with normalgrowth and development.4. No Clinical orradiographic evidence of jaw pathologies.Exclusion Criteria:1.History of Extraction ormissing teeth2.History of Orthodontic treatment.The subjects were grouped into two groups.Youngerchildren included 7 yearsold, twentyindividuals agedbetween 6½years and 7½years in which 10 wereboys and 10 were girls. Older children included 11yearsold, twentyindividuals between 10½ yearsand11.6 years in which ten were boys and tenwere girls.The chronological age was calculated according tothe data provided in the school register.For data analysis paired samples‘t’ tests were applied to compare chronological age to Nolla’s age values ,for boys, girls andfortotal sample. Nolla’s m ethod of Dental Age Estimation 6 :Nolladevised a method of age estimation by evaluating theCalcification ofthe permanent dentition. TheCalcification of permanent dentition was divided into10 stagessuch as 1) Absence of crypt. 2) Presence of Crypt. 3) Initial Calcification. 4) 1/3 rd Crowncompleted. 5) 2/3 rd crown completed. 6) Crownalmost completed. 7) Crown completed 8)1/3 rd rootcompleted. 9) 2/3 rds of Root Completed. 10) Rootalmost Completed  –  open apex. 11) Apical end of root completedfor each group of teeth like incisors,canine, premolars and molars of maxillary andmandibular arches separately. The radiograph of theindividual was matched with a comparative figuregiven by Nolla. Eachtoothwasrecorded with areading and a sum total is made for maxillary andmandibular teeth. Later the sum total is comparedwith table given by Nolla. Separate tablewas givenfor boys and girls and including or excluding thirdmolars. 1,6,7 The opg of the subjects ofyounger childrenandolderchildrenwere matched with the figures of calcification given by Nolla. Seven mandibular teethand seven maxillary teeth onthe left quadrantwererecorded for stage of calcification with a reading.Fig 1: Orthopantomograph used in the studyA sumtotal is made for seven mandibular and sevenmaxillary teeth to derive a score for fourteenmaxillary and mandibular teeth. Later the sum total is matched with the table given by Nolla’s for boys and girls separately. RESULTS In the present study Nolla’s method of dentalageestimation was done and later checked withchronological age.When boys and girls ofyounger childrenwasconsidered together mean dental age,according to  Nolla’s was 6.48 ± 0.73 years and the mean chronological age was 7.3 ± 0.12years.  275 Nandlaletal.,Int J Med Res Health Sci. 2014;3(2):273-277 Table 1: Results of Younger children SexYounger children (7year Old)Older children(11year old)AgeMean±SDMeandiff  ‘t’ value ‘p’ valueMean ±SDMeandiff  ‘t’ value ‘p’ valueBoysChronological7.31±0.120.614.12.003**11.30±0.162.458.518.000**  Nolla’s 6.70±0.428.85±0.88GirlsChronological7.29±0.131.043.65.005**11.32±0.151.775.053.001**  Nolla’s 6.25±0.929.55±1.17TotalChronological7.30±0.120.825.03.000**11.31±0.152.119.019.000**  Nolla’s 6.48±0.739.20±1.07 Note : ** significant at p< .01 level The mean dentalage, according to Nolla’s in Younger children Boys was 6.70 ± 0.42 years whilethe mean chronological age was 7.31± 0.12 years. Inyounger children Girls the mean dentalage,according to Nolla’s was 6.25 ± 0.92 years and mean chronological age was 7.29 ± 0.13 years.InYounger children  Nolla’s method underestimated the age of subjects by 0.82 years,which was verysignificant with p value of 0.000.The mean dental age,according to Nolla inOlderchildren,boys,was 8.85 ± 0.88 years and the meanchronological age was 11.30± 0.16 years.InOlderchildrenGirls the mean dentalage,accordingto Nolla was 9.55 ± 1.77 years and meanchronological age was 11.32± 0.15 years.In older children , Nolla’s method underestimatedtheage of subjects by 2.11 years,which was verysignificantwith pvalue of 0.000.When boys and girls ofolder childrenwas consideredtogether mean dentalage, accordingto Nolla was9.20 ± 0.15 years and the mean chronological age was11.31 ±0.15 years.The results of the study showed that the dental age of   Nolla’s underestimated the age of the individuals very significantly with p value of 0.000 in both thegroups. DISCUSSION Identification ofanindividual has been themainstayof civilization. Not only is identification of thediseased a necessity, but also the living an importantintegral part of our daily life. It may be necessary to estimate an individual’s age in situations such as identification, criminalresponsibility, judicial punishment, consent,rape,criminal abortion, employment, attainment of majority, kidnapping andprostitution, etc.for legalrequirements. 8,9 InIndiadue to lower literacy status,parents and their children do not have accurateknowledge of their date of birth records which wouldbe required in legal matters concerningthe ageof theindividual.The timing and sequence of various stages of toothdevelopment from firstappearancesof cusps to rootapical closure follow a rigid pattern. Hence thedeveloping dentition can be used for assessment of age.The bone development, secondary sexualcharacteristics and stature or weight are otherdevelopmental indicators apart from dentition,butcan be applied only aftertheinceptionof puberty. 1,5 Age estimation using dentition could be done by twomethods such as 1) atlas method, where development(mineralization) of dentition is compared withpublished standards. 2) Scoring method, wherethedevelopment of dentition is divided into variousstages and are assigned scores and evaluated throughstatistical analysis.Nollasmethod 6 isa scoring system for age estimationby studying the calcification of permanent teeth. Hedivided the calcificationof permanent dentition intostagessuch as 1) Absence of crypt. 2) Presence of Crypt. 3) Initial Calcification. 4) 1/3 rd Crowncompleted. 5) 2/3 rd crown completed. 6) Crownalmost completed. 7) Crown completed 8)1/3 rd rootcompleted. 9) 2/3 rds of Root Completed. 10) Rootalmost Completed  –  open apex. 11) Apical end of root completed.  276 Nandlaletal.,Int J Med Res Health Sci. 2014;3(2):273-277This is a realistic & no invasive method of ageestimation which was followed in this study and latercomparedwith chronological age.In younger children among boys theunderestimationof Chronological age was 0.61 years and girls were1.04 years.In older children among boys the underestimation of Chronological age was 2.45 years and girls were 1.77years.The dental age derived in this study was significantlylower than the chronological age of the individuals inboth the groups and there wasa differencebetweenboys and girls within the groups. In both the groups, Nolla’s underestimated the chronological age of the individual. Theunderestimation of age increased asthe chronologicalage of the individual increased.The causes for underestimation of age could be:The timing of tooth development is highly heritableand also population specific. Two differentpopulations were compared in a study concludedthat, distinct stages in tooth development differremarkably up to two years between differentethnicities. 10,11  Nolla’s method may not be applicable to this population hence a population specific datashould be used for age estimation.The possible influences of environment andhereditary on dental age is also debatable.Consistently low correlations indicate the lack ofaclear associationbetween tooth formation andparameters like social status, nutritional effects andsomatic development. 12,13 Dental developmentshows no significant relationships with maturityindicators such as menarche, peak height velocity orskeletal maturity. 14 These results imply that themechanisms controlling dental growth anddevelopment are independent of general growthmechanisms but closely approximate chronologicalage.Odontological age estimation is dependent on threefactors such as 1) the subject of age estimation. 2)Appropriately chosen dental developmental survey&3) legal consideration.Hence, toposition anindividual upon apractical time scale, two or moremethods of age estimation should be considered judiciously, giving wattage to the above tridentfactors. CONCLUSION  Nolla’s method of age estimation was not found to be accurate in both the age groups.Studies involvinglarger sample size and a population specific data forthe children of southern India for dental ageestimation should be developed. ACKNOWLEDGEMENT The authors wish to thankDr.Mahima Patil , Professor, Dept. of Oral Medicine & Radiology JSSDental College and Hospital,for valuable assistanceand help. REFERENCES 1.Karjodkar FR.Role of dental radiology inforensic odontology, Text book of dental andmaxillofacial radiology.New Delhi: JaypeeBrothers Medical Publishers (P) Ltd, 2009:2 nd editon:929  –  963.2.Masthan KMK. Age estimation by teeth.Textbook of forensic odontology. New Delhi,Jaypee Brothers Medical Publishers (P) Ltd,2009:92  –  97.3.Masthan KMK. Age and sex. Textbook of forensic odontology. New Delhi: Jaypee BrothersMedical Publishers (P) Ltd, 2009:59  –  65.4.PanchbhaiAS. Review Dental radiographicindicators, a key to age estimation.Dentomaxillofacial Radiology 2011; 40 :199-125.Achary AB, Sivapathasundharan B. Forensicodontology. In: Rajendran R, Sivapathasundharan B, (eds). Shafer’s tex tbook of oral pathology (6thedn). India: Elsevier Private Ltd, 2009, pp 871  –  892.6.Nolla CM. The development of permanent teeth.J Dent Child 1960; 27: 254  –  66.7.Abou El-Yazeed M, Abou Zeid W, Tawfik W.Dental Maturation Assessment by Nolla'sTechnique on a Group ofEgyptian Children.Australian Journal of Basicand AppliedSciences2008. 2(4): 1418-24.8.Amandeep Singh, Gupta VP, Das Sanjoy.Physiological changes in teeth as atooltoestimate age. The Pacific Journal of Science andTechnology 2009;10(2):956-65.9.Chaudry K, Agarwal A,Rehani U. Applicability of Demirjian’ s Method for Dental Age  277 Nandlaletal.,Int J Med Res Health Sci. 2014;3(2):273-277Estimation. Indian Journal of Dental Sciences2010;4: 1-3.10.Alexandra Meinl. The Application of Dental AgeEstimation Methods: Comparative Validity andProblemsin Practical Implementation. DoctoralthesisUniversity of Wein2007..11.OlzeA, SchmelingA,TaniguchiM, MaedaH,Van Niekerk,WerneckeKD,GeserickG.Forensic age estimation in living subjects: theethnic factor in wisdom toothmineralization, Int.J. Legal Med 2004. 118: 170-73.12.GarnSM, LewisAB,BlizzardRm.EndocrineFactors in Dental Development.J.Dent. Res1965. 44 : 243-58.13.Demirjian A, Goldstein H, Tanner JM. A newsystem of dental age assessment. Hum Biol 1973;45: 211  –  227.14.DemirjianA,BuschangPH,TanguayR,PattersonDK.Interrelationships amongmeasuresof somatic, skeletal, dental, and sexual maturity,Am. J. Orthod 1985 . 88: 433-438.

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