Performance of Willem’s dental age estimation method in children: A systematic review and meta-analysis

• Published in: Forensic science international Vol. 280; pp. 245.e1 - 245.e10
• Main Authors: Mohd Yusof, Mohd Yusmiaidil Putera, Wan Mokhtar, Ilham, Rajasekharan, Sivaprakash, Overholser, Rosanna, Martens, Luc
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01-11-2017; Elsevier Limited
• Subjects: Accuracy; Age determination; Age groups; Children; Chronology; Dental age estimation; Dental materials; Females; Finite element method; Forensic odontology; Forensic sciences; Males; Meta-analysis; Population studies; Populations; Quantitative analysis; Search methods; Statistical analysis; Subgroups; Systematic review; Willem’s method; Willem’s method; Dental age estimation; Children; Meta-analysis
• ISSN: 0379-0738; 1872-6283
• DOI: 10.1016/j.forsciint.2017.08.032

•Willems method accurately estimated age for less than one year on error rate.•Age estimation difference ranges from 0.01 years to 0.69 years for both genders.•No statistical significant in the mean difference between regions.•Population-specific reference has no effect on accuracy of dental age estimation.•Mean difference between younger and older children is the same.
Through numerous validation and method comparison studies on different populations, the Willems method exhibited a superior accuracy. This article aims to systematically examine how accurate the application of Willems dental age method on children of different age groups and its performance based on various populations and regions. A strategic literature search of PubMed, MEDLINE, Web of Science, EMBASE and hand searching were used to identify the studies published up to September 2014 that estimated the dental age using the Willems method (modified Demirjian), with a populations, intervention, comparisons and outcomes (PICO) search strategy using MeSH keywords, focusing on the question: How much Willems method deviates from the chronological age in estimating age in children? Standardized mean differences were calculated for difference of dental age to chronological age by using random effects model. Subgroup analyses were performed to evaluate potential heterogeneity. Of 116 titles retrieved based on the standardized search strategy, only 19 articles fulfilled the inclusion criteria for quantitative analysis. The pooled estimates were separately kept as underestimation (n=7) and overestimation (n=12) of chronological age groups for both genders according to primary studies. On absolute values, females (underestimated by 0.13; 95% CI: 0.09–0.18 and overestimated by 0.27; 95% CI: 0.17–0.36) exhibited better accuracy than males (underestimated by 0.28; 95% CI: 0.14–0.42 and overestimated by 0.33; 95% CI: 0.22–0.44). For comparison purposes, the overall pooled estimate overestimated the age by 0.10 (95% CI: −0.06 to 0.26) and 0.09 (95% CI: −0.09 to 0.19) for males and females, respectively. There was no significant difference between the young and older child in subgroup analysis using omnibus test. The mean age between different regions exhibited no statistically significant. The use of Willems method is appropriate to estimate age in children considering its accuracy among different populations, investigators and age groups.