Comparison of Two Dental Age Estimation Methods:

The London Atlas and the Schour & Massler Atlas

in 3-23 Years Old Indonesian

Aprianisa Obsidiany Daisy Tarigan

, Hendra Polii

and Rosalina Intan Saputri

Undergraduate Program, Faculty of Dentistry, Maranatha Christian University, Jalan Surya Sumantri 65 Sukajadi,

Kota Bandung, Indonesia 40164

Faculty of Dentistry, Maranatha Christian University, Jalan Surya Sumantri 65 Sukajadi, Kota Bandung, 40164, Indonesia

Keywords: Dental, Age Estimation, Schour and Massler, London Atlas, Forensic Odontology.

Abstract: Age estimation is an important process in forensic identification, especially when there is insufficient

antemortem information. Tooth is one of the strong variables which could be used in estimating the age of

living or deceases. Non-invasive age estimation methods, including dental radiographs, have the advantage

of uncomplicated application without damaging the oral and surrounding tissues. The aim of this research

was to compare two radiographic dental age estimation methods, the London Atlas by Al Qahtani and the

Schour & Massler Atlas in 3-23 years old Indonesian population. Two hundred and fifty-three panoramic

radiographs from 156 females and 97 males with age ranged between 3-23 years old were retrospectively

collected from a Dental Hospital. Age estimation was performed on the radiographs using the London Atlas

and the Schour & Massler Atlas. Mann-Whitney U test was used to compare the chronological age and

estimated age from two methods. There was an insignificant difference between estimated age by both Atlases

(p> 0.05). Furthermore, there was also insignificant differences between estimated age of both Atlases and

the chronological age (p> 0.05). The performance of London Atlas and Schour & Massler Atlas were

equivalent in estimating 3-23 years old Indonesian in present study population.

1 INTRODUCTION

Age is an important identity. It is a basic human right

for an individual to know their dates of birth, hence

their ages (Cameriere et al., 2007). Age is required for

civil administration, such as school, registration,

work application, and retirement. Individual age also

plays a significant role in jurisdiction, such as cases

of employment, age falsification, marriage, athletes,

child custody, and immigration (Panchbhai, 2011).

However, there are possibility that the chronological

age of an individual is unknown because their

documented identities is not available or there is an

indication of falsification which required

examination for age estimation (Putri et al., 2015).

The chronological age can be estimated by

determining the physiological development of certain

organs (Adams et al., 2014). Teeth were being used

as a choice of age indicator because they are the

https://orcid.org/0000-0003-0811-6270

strongest parts of the human body, and can withstand

external influences such as high temperatures,

explosions, and other extreme conditions. Human

teeth also tend to be stable and barely affected by

other environmental factors such as socioeconomic

status, nutrition, diet, and even endocrine factors.

Therefore, teeth can be useful in the post-mortem

examination (Kaur et al., 2013; Adams et al., 2014).

Dental age can be determined by the development

of human teeth which occurs nearly one third of the

human life period. Radiograph was often used for

dental age estimation because of its non-invasive

method and does not involve tooth extraction (Putri et

al., 2015). One of the radiography techniques is atlas

method which consist of diagrammatic pictures of

developing teeth’s structure with related eruption

patterns (Senn, 2013). London Atlas by Al Qahtani

and Schour & Massler Atlas were the most popular

Atlas for dental age estimation which had not

122

Tarigan, A., Polii, H. and Saputri, R.

Comparison of Two Dental Age Estimation Methods: The London Atlas and the Schour Massler Atlas in 3-23 Years Old Indonesian.

DOI: 10.5220/0010745600003113

In Proceedings of the 1st International Conference on Emerging Issues in Technology, Engineering and Science (ICE-TES 2021), pages 122-125

ISBN: 978-989-758-601-9

compared in Indonesia population. London Atlas by

Al Qahtani has 31 diagrams that describe the

development of teeth from 30 weeks of pregnancy to

the age of 23.5 years. Eight of these diagrams only

describe the development of third molars starting at

the age of 16.5 years. Whereas in Schour & Massler

Atlas, it describes 21 chronological steps of tooth

development from 5 months of pregnancy to 21 years.

Besides that, individual studies from these atlases in

Indonesian population only had small number of

samples, which was around 20 to 100 subjects. The

estimated age scope from both atlases is relatively

similar, which is around the prenatal age to 21 years,

which would supplement the comparison results of

both methods in different population (Senn, 2013;

Ciapparelli, 1992; Schour et al., 1941). Therefore,

this research aimed to compare the London Atlas by

Al Qahtani and the Schour & Massler Atlas in

Indonesian population.

2 METHODS (AND MATERIALS)

The panoramic radiographs of 253 individuals (males

= 97, females = 156) aged 3-22.99 years old were

retrospectively and anonymously collected from

Maranatha Dental Hospital. The selected radiographs

should meet the following inclusion criteria: data for

male or female patients aged 3-22.9 years and right

upper and lower jaw teeth were clearly visible on

panoramic radiographs. While the exclusion criteria

were missing tooth / no tooth seed and pathological

structure of tooth and surrounding tissue in the region

studied in the panoramic view, currently undergoing

orthodontic treatment, having systemic complication,

such as poor nutrition or congenital diseases.

Age estimation was performed on the radiographs

using the London Atlas by Al Qahtani and the Schour

& Massler Atlas (Al Qahtani et al., 2014; Schour et

al., 1941). The inter-rather reliability between two

examiners was 76%. Mann-Whitney U test was used

to compare the chronological age and estimated age

from two methods. Ethical clearance was granted by

Faculty of Medicine, Maranatha Christian University

Research Ethic Committee (006/KEP/II/2021).

3 RESULTS AND DISCUSSION

3.1 Study Population

The percentage of sex in this study displayed in Table

I. From 253 respondents the highest chronological

age (11%) was between 5.0 and 5.99 years, then 8%

was between 19.0 to 19.99 years, and at least 1% of

respondents have the chronological age between 22.0

and 22.9 years (Figure 1).

Table 1: Number and Percentage of Study Population by

Sex.

Sex Amount (n) Percentage

Male 97 38%

Female 156 62%

Total 253 100%

3.2 Comparison between Chronological

Age and Two Dental Estimation

Methods

Analysis by Kolmogorov-Smirnov test showed that

chronological age, age estimation of London Atlas by

Al Qahtani method, and age estimation of the Schour

& Massler method were not normally distributed

(p<0.01). Therefore, Mann-Whitney U test was

performed. There was an insignificant difference

between the age estimation results of London Atlas

by Al Qahtani method and the age of the Schour &

Massler method. Moreover, there was also an

insignificant different between two methods with

chronological age (Table 3).

Table 2: Statistical p-value between Chronological Age, Al-

Qahtani Atlas Method, and Schour & Massler Method.

London Atlas by

Al Qahtani

Method

Schour and

Massler Method

Chronological

Age

0.982 0.575

London Atlas

by Al Qahtani

Method

0.574

3.3 Discussion

There are different methods in estimating the age in

forensic dentistry, including the London Atlas by Al

Qahtani method and the Atlas Schour & Massler

method. London Atlas by Al Qahtani method and the

Schour & Massler method are often used because

they are uncomplicated, costs effective, and mostly

not invasive, which do not damage dental tissue

(Alshihri et al., 2015). However, the Atlas methods

also have limitations, such as the inability to represent

all cases and the variability of development in tooth

Comparison of Two Dental Age Estimation Methods: The London Atlas and the Schour Massler Atlas in 3-23 Years Old Indonesian

123

formation time and tooth eruption stages and the

inability to differentiate between sexes (Alshihri et

al., 2015). In estimating dental age, crown and root

development, and eruption status in the specimens,

the diagram of London Atlas by Al Qahtani method

and the Schour & Massler Atlas method was adjusted.

This study was conducted to compare the accuracy in

estimating dental age with the London Atlas by Al

Qahtani method and Schour & Massler Atlas method

on panoramic radiographs (Alshihri et al., 2015).

A study by Al Qahtani et al. (2014) has compared

three methods in estimating age between the Schour

& Massler, Ubelaker and London Atlas (Al Qahtani)

methods in Portugal, Netherlands, United States,

Canada and France, which resulted that the Al

Qahtani Atlas method is the most accurate method

compared to other methods. The differences between

previous and this study was Al Qahtani et al. study

did not use the third molars for age estimation (Al

Qahtani et al., 2014), which included in this study. A

study conducted by Pavlovic et al (2017) who

examined the Al Qahtani Atlas method in 498 women

and 238 men in Portugal and found no significant

difference between chronological age and age

estimation using the London Atlas (Al Qahtani) in the

female sample only (Pavlović et al.,2017). The

drawback of this study is that it does not differentiate

between sex and the results only showed that there is

an insignificant difference in mixed sexes.

The differences in the results of previous studies

were also possible because of different study

population of each country. Racial differences could

lead to differences in the timing and sequence of

eruption of permanent teeth (Indriati E, 2001). Study

in Indonesia population had conducted by Fitri et al

(2016), which studied the age estimation using the Al

Qahtani method and identified 94 samples, and there

were 66 samples (70.21%) which showed similar

result between Al Qahtani age estimation method and

the chronological age (Rusydiana et al.,2016). It was

in agreement with present study result which

demonstrated that the Al Qahtani method has

insignificant differences with chronological age.

Another study which in the agreement with current

study was study by Nurfitria et al (2018) which used

the Atlas Al-Qahtani method, as a method of

estimating age and found that the difference in dental

age and chronological age was very small and could

be used in the population in Indonesia (Nurfitria et

al.,2018).

The exclusion criteria of this study were patients

should not have poor nutrition and a history of

systemic and congenital diseases, which in-line with

the study of Eshitha et al (2014) who estimated the

age of 25 children aged 5-16 years in good health in

a population in India using the Schour & Massler

method. From the study was found that the intraclass

correlation coefficient was 0.938 which indicates a

Figure 1: Number of study population per age category.

0 5 10 15 20 25 30

3.0 - 3.99 years

5.0 - 5.99 years

7.0 - 7.99 years

9.0 - 9.99 years

11.0 - 11.99 years

13.0 - 13.99 years

15.0 - 15.99 years

17.0 - 17.99 years

19.0 - 19.99 years

21.0 - 21.99 years

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high correspondence between chronological age and

dental age according to Schour & Massler, so it could

be concluded that the Atlas Schour and Massler

method can be applied to mentioned population

(Eshitha E et al., 2014). In addition, study by Trelia et

al. (2019) estimated age using the Atlas Schour &

Massler and Demirjian method with sample of 46

patients with the age range of 10-16 years at the

RSGM University of North Sumatra and showed that

age estimation results were similar to the actual age,

so there was no significant differences between two

methods (Trelia et al., 2019). This study is in

agreement with Trelia et al. research that the Schour

& Massler method is proven to be able to estimate

dental age in Indonesia population.

Besides there is no sex distinction, the

disadvantages of current study were uneven

distribution of the age range and there was no specific

analysis for each gender. Therefore, future research

should aim for enlarging the research population with

even sample per age range, and perform sex-specific

analysis.

4 CONCLUSIONS

It could be concluded that the performance of London

Atlas and Schour & Massler Atlas were equivalent in

estimating present study population.

ACKNOWLEDGEMENTS

We would like to thank drg.Citra Esperanza for the

time and effort as the second observer, as well as

Danny Prasetyo Hartanto, S.Si who helped in data

processing and analyzation of this study.

REFERENCES

Adams, C., Carabott, R., Evans, S. (2014). Forensic

odontology: an essential guide. Oxford: Wiley

Blackwell.

Alshihri, A.M., Kruger, E., Tennant, M. (2015). Dental Age

Assessment of Western Saudi Children and Adolescent.

Saudi Dent J. 27(3), 131-136.

Al Qahtani, S.J., Hector, M.P., Liversidge, H.M. (2014).

Accuracy of dental age estimation charts: Schour and

Massler, Ubelaker and the London Atlas. Am. J. Phys.

Anthropol. 154(1),70–78.

Cameriere, R., Ferrante, L., Belcastro, M.G., Bonfiglioli,

B., Rastelli, E., Cingolani, M. (2007). Age Estimation

by Pulp/Tooth Ratio in Canines by Mesial and

Vestibular Peri-Apical X-Rays. J. Forensic. Sci. 52(5),

1151–1155.

Ciapparelli, L. (1992). The chronology of dental

development and age assessment. In: Clark DH, editor.

Practical Forensic Odontology. Oxford: Wright

Butterworth‑Heinemann Ltd.

Eshitha, E., Prasanna, K.R., Laxmikanth C., Prashanth S.,

Veena, K.M., Rachana V.P., Shahin K.A., Tashika K.,

Prathima S., Shaul Hameed. (2014). Dental Age

Estimation Using Schour and Massler Method in South

Indian Children. Scholars. SJAMS. 2(5c), 1669–1674.

Indriati, E. (2013). Permanent Tooth Eruption in Javanese

Children. B. I. Ked. 33(4), 237-248.

Kaur, J., Rai, B. (2013). Evidence-Based Forensic Dentisty.

Berlin: Springer.

Lemeshow. S., David, W.H.Jr. (1997) Besar Sampel dalam

Penelitian Kesehatan (Terjemahan). Yogyakarta:

Gadjahmada University Press.

Nurfitria, D.T., Soedarsono, N., Yuniastuti, M., Nehemia,

B. (2018) Comparison of TCI–Benindra formula, Al-

Qahtani, and Blenkin-Taylor methods for age

estimation in 16–21 year olds. IOP Science.

1073:022012.

Panchbhai, A. (2011). Dental radiographic indicators, a key

to age estimation. Dentomaxillofac Radiol. 40(4),199–

212.

Pavlović, S., Pereira, C.P., Santos, R.F. (2017). Age

estimation in Portuguese population: the application of

the London atlas of tooth development and eruption. J.

Forensic. Sci. 272, 97-103.

Peretz, B., Gotler, M., Kaffe, I. (2012). Common errors in

digital panoramic radiographs of patients with mixed

dentition and patients with permanent dentition. Int. J.

Dent. 584138.

Putri, A.S., Nehemia, B., Soedarsono, N. (2015). Prakiraan

usia individu melalui pemeriksaan gigi untuk

kepentingan forensik kedokteran gigi. Jurnal PDGI.

62(3),55-63.

Rusydiana, F., Oscandar, F., Sam, B. (2016). Identifikasi

usia berdasarkan metode Al Qahtani melalui radiograf

panoramik di RSGM FKG UNPAD. J. Ked. Gi. Unpad.

28(3),1-6.

Senn, D.R., Weems, R.A. (2013). Manual of forensic

odontology, 5th edition. Boca Raton: CRC Press Taylor

& Francis Group.

Smrithi, D. (2014). Coronal Pulp biomarker: A lesser

known age estimation modality. JIAOMR

.26(4),398-

404.

Schour, I., Massler, M. (1941). Development of human

dentition. J. Am. Dent. Assoc.20, 379‑427.

Trelia, B., Tiara, A. (2019). Estimasi Usia Menggunakan

Metode Schour-Massler Dibandingkan dengan Metode

Demirjian. DENTIKA. 22(1), 15-19.

Willems, G.A. (2001). Review of the most commonly used

dental age estimation techniques. J. Forensic

Odontostomatol. 19(1),9-17.

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