Age Estimation From Pulp Cavity Analysis Using Cone Beam Computed Tomographic Images for Forensic Purposes

Forensic Assessment of Age From Pulp Cavity Using Cone Beam Computed Tomographic Images (An Observational Cross- Sectional Study)

Forensic odontology is a branch of forensic science that utilizes a dentist's expertise in identification of individuals for whom traditional methods of identification aren't accessible due to a lack of common identification features. Medico-legal issues, natural catastrophes such as tsunamis, earthquakes, and explosions, death verification in monetary concerns, religious and social reasons are all examples of situations that require identification. Age, stature, sex and ethnicity are the "big four" determinants of personal identification. Dental age estimation has the benefit of that teeth are less influenced by external physical, chemical, or mechanical variables than other portions of the skeleton. Secondary dentin deposition in human teeth progresses with age that results in reduction in the size of the tooth pulp cavity which can be assessed as an age indicator. A significant relationship between pulp width and age was originally discovered in a study by Kvaal et al., 1995 who created regression formulae for age prediction using periapical radiograph by measuring of pulp size. Also, the assessment of pulp/tooth volume ratio relying on the gradual reduction in pulp volume produced by continuous apposition of dentin during life is one well-known dental age estimation approach. Cone beam computed tomography (CBCT) provides accurate three-dimensional images of the maxillofacial area. In addition, CBCT may be beneficial in some forensic situations, as it has massive benefits for post-mortem forensic imaging, as it offers skeletal imaging with high resolution, cheap cost, simplicity and portability. CBCT can be used in forensic age assessment since it is non-invasive and allows for the reconstruction of images in multiple planes to display anatomical and imaged elements in distinct planes. Our hypothesis is that pulp space analysis is totally different between different ages and that there is a correlation between age and pulp space analysis that could be of a forensic significance for age estimation in the investigated population.

Study Overview

• Status: Recruiting
• Conditions: Healthy
• Intervention / Treatment: Radiation: CBCT

Detailed Description

In this observational cross-sectional study, cone beam computed tomography scans will be recruited that are with the required complement of teeth and in the age range between 20 and 60 years then, correlation between chronological age versus cone beam computed tomography age through pulp space analysis will be done by two methods which are linear measurements and volumetric measurements of pulp and tooth size. First, linear measurements will be done according to kvaal's et al approach, measurements from mandibular lateral incisors, canines and first premolars and maxillary central and lateral incisors and second premolars were most strongly correlated with age, so these teeth will be selected for the investigation. A paired t-test on these measurements showed that there were no significant differences between teeth from the left and the right side of the jaw. Consequently, teeth from either the left or the right side will be chosen, whichever will be best suited for measurement. Not knowing the age and gender of the individual, the following measurements will be carried out on the radiographs of all six types of teeth: the maximum tooth length (T), pulp length and root length (R) on the mesial surface from the enamel-cementum junction (ECJ) to the root apex, the root and pulp width both at the ECJ (level A) and at the midroot level, i.e. halfway between the ECJ and the apex of the root (level C), as well as at the midpoint between the ECJ and midroot level (level B). Second, volumetric Measurements will be done to calculate pulp/ tooth volume ratio.

• Study Type: Observational
• Enrollment (Anticipated): 25

Contacts and Locations

• Study Contact: Name: Christine Beshara; Phone Number: +201273539853; Email: christine.beshara@dentistry.cu.edu.eg

Study Locations

• Egypt
  • Cairo, Egypt
    • Recruiting
    • Faculty of Dentistry, Cairo University
    • Contact: Christine Beshara; Phone Number: 01273539853; Email: christine.beshara@dentistry.cu.edu.eg

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 20 years to 60 years (Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

CBCT scans that meet the eligibility criteria for age estimation

Description

Inclusion Criteria:

• CBCT scans for male and female Egyptians between the ages of 20 and 60 years.
• CBCT scans with the required complement of teeth.

Exclusion Criteria:

• CBCT scans that lack a proof of age or date of birth.
• CBCT scans with the required teeth showing pathological processes in the apical bone.
• CBCT scans with overlying teeth.
• CBCT scans in which the required teeth were filled, prosthetically restored or carious.

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Single group; Single group will be selected for age estimation using CBCT Scans	Radiation: CBCT; Cone beam computed tomographic images selected for age estimation

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pulp/ tooth volume ratio CBCT age to be correlated with chronological age	Pulp/ tooth volume ratio CBCT age to be correlated with chronological age using volumetric segmentation of CBCT software in mm3.	Through study completion, an average of 1 year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Analysis of pulp size using linear measurements.	Analysis of pulp size using linear measurements tool of CBCT software in mm.	Through study completion, an average of 1 year

Collaborators and Investigators

• Sponsor: Cairo University
• Investigators: Principal Investigator: Christine Beshara, Cairo University

Publications and helpful links

General Publications

• Asif MK, Nambiar P, Mani SA, Ibrahim NB, Khan IM, Lokman NB. Dental age estimation in Malaysian adults based on volumetric analysis of pulp/tooth ratio using CBCT data. Leg Med (Tokyo). 2019 Feb;36:50-58. doi: 10.1016/j.legalmed.2018.10.005. Epub 2018 Oct 21.

Study record dates

Study Major Dates

• Study Start (Actual): April 2, 2022
• Primary Completion (Anticipated): November 1, 2022
• Study Completion (Anticipated): December 1, 2022

Study Registration Dates

• First Submitted: November 8, 2021
• First Submitted That Met QC Criteria: November 17, 2021
• First Posted (Actual): November 22, 2021

Study Record Updates

• Last Update Posted (Actual): August 30, 2022
• Last Update Submitted That Met QC Criteria: August 29, 2022
• Last Verified: August 1, 2022

More Information

Terms related to this study

• Keywords: CBCT; Forensic dentistry; Age determination by teeth
• Other Study ID Numbers: Christine Atef ORAD 7-1-1

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No