Short Communication Demirjian’s stages and Cameriere’s third molar maturity index to estimate legal adult age in Peruvian population Roselhy Juliana Quispe Lizarbe a , Christian Solís Adrianzén a , Milushka Miroslava Quezada-Márquez a , Ivan Galic ´ b,⇑ , Roberto Cameriere c a Faculty of Dentistry, Cientifica del Sur University-UCSUR, Lima, Peru b University of Split School of Medicine, Spinc ˇic ´eva 2, 21000 Split, Croatia c AgEstimation Project, University of Macerata, Macerata, Italy article info Article history: Received 13 September 2016 Received in revised form 2 January 2017 Accepted 12 January 2017 Available online 16 January 2017 Keywords: Legal medicine Peru Forensic dentistry Age determination by teeth Third molar Adult age abstract Objective: To compare the accuracy of Demirjian’s stages (DS) and Cameriere’s third molar maturity index cut-off value (I 3M < 0.08) to estimate the age of majority on panoramic radiographs (OPTs) from the dental clinic of the Scientific University of the South (UCSUR), Lima, Peru. Methods: An observational cross-sectional study was conducted on the sample of 208 digital panoramic radiographs of patients aged 14–22 years examined during 2015 in UCSUR. The left lower third molars were analyzed using Adobe Photoshop Ò CS6. An effectiveness of specific DS and I 3M < 0.08 was evaluated by using accurate classification, sensitivity, specificity, positive (LR+) and negative (LRÀ) likelihood ratios and Bayes post-test probability (p). Results: Only G and H stages were practical for classify adults and minors in the tested sample, while I 3M < 0.08 showed the best performance in both sexes. For I 3M < 0.08, the accurate classification, sensitiv- ity and specificity were 0.96, 0.96, 0.96 and 0.90, 0.84 and 0.95 in males and females, respectively. Values of LR+, LRÀ and p were 24.96, 0.04, 0.97 and 15.68, 0.17, 0.95 in males and females, respectively. Conclusion: The specific cut-off value of third molar maturity index (I 3M < 0.08) showed to be more accu- rate in discriminating adults and minors in Peruvian sample when a test with high sensitivity and speci- ficity is required. Ó 2017 Elsevier B.V. All rights reserved. 1. Introduction The estimation of age in individuals and particularly the assess- ment of the age of majority is part of the contemporary forensic practice [1–6]. The importance of properly discriminate adults and minors is related to their different treatment in specific civil and penal law [6–8]. The assessment of the biological age of a sub- ject around 18 years old became a serious problem for forensic experts, and a distinction must be drawn between post-mortem or skeleton cases and age estimation in living subjects [9]. There are several matters that involve age estimation in living subjects such as adoption processes, identification when any kind of identification documents is not available, examination of young detainees as a result of illegal or criminal acts [9,10]. There is an allegation of a minority as a mean of attaining the benefit of protection that criminal law grants to minors [11–14]. The medical approach to detect the age of majority includes assessing the maturity of the bones, dental maturity and physical development [15]. The international interdisciplinary Study Group on Forensic Age Diagnostics (AGFAD) issued recommendations which include a combination approach based on physical and den- tal examination together with the wrist of the left hand [9]. Dental maturation is a uniform process in different populations, although there may be variations in the progress or delay in the timing of mineralization [16,17]. For teenagers and young adults, whose dental maturation has almost completed, the only develop- ing teeth are the third molars (TMs). The third molar assessment as an indicator of age has become very important in recent years, both in the forensic and the legal area [18]. Therefore, the analysis of TMs in populations with different geographical and ethnic back- grounds in the age range near the legal age of majority is para- mount. There are several methods for estimating the dental maturation using TMs [17,19,20]. Demirjian et al. [21] published in 1973 one of the main methods used to quantify the degree of the dental maturation. Costa et al. [19] used G and H stages of Demirjian on the development of TM as cut-offs to estimate the http://dx.doi.org/10.1016/j.legalmed.2017.01.003 1344-6223/Ó 2017 Elsevier B.V. All rights reserved. ⇑ Corresponding author. E-mail address: igalic@mefst.hr (I. Galic ´). Legal Medicine 25 (2017) 59–65 Contents lists available at ScienceDirect Legal Medicine journal homepage: www.elsevier.com/locate/legalmed