Applicability of Demirjian’s method for age estimation in a sample of Italian children with Down syndrome: A case-control retrospective study Simone Bagattoni*, Giovanni D’Alessandro, Maria Rosaria Gatto, Gabriela Piana Department of Biomedical and Neuromotor Sciences (DiBiNeM), Unit of Dental Care for Special Needs Patients and Pediatric Dentistry, University of Bologna, Bologna, Italy A R T I C L E I N F O Article history: Received 5 February 2018 Received in revised form 28 February 2019 Accepted 8 March 2019 Available online 15 March 2019 Keywords: Down syndrome Dental age Demirjian’s method A B S T R A C T Age estimation is widely applied in several clinical and forensic fields. The radiographic evaluation of dental development is one of the most accepted tools for this purpose. Among the different methods proposed, Demirjian’s method was the most extensively used and tested in the medical literature revealing that the original standards for the French–Canadian population tends to over-estimate the age of different population groups. The aims of this study were to evaluate the applicability of the Demirjian method in a sample of Italian children with Down syndrome (DS) and to compare the data with age and gender matched healthy subjects (non-DS). A retrospective study was performed on 146 orthopantomo- grams of DS individuals aged 6.3–16 years. The mean chronological age (CA) and the mean dental age (DA) were calculated. Using Cohen’s kappa statistics, the inter- and intra-examiner agreement was reported as good (k = 0.75) and very good (k = 0.86). The differences between CAs and DAs were statistically significant for males and females (Wilcoxon Signed Rank test; p < 0.05). The median overestimation was 0.6 years in males and 0.9 years in females. Demirjian’s method is unsuitable for dental age estimation in DS individuals. The same trend in overestimation was found in the control group. Comparing DS and non-DS subjects, the differences between DAs were not statistically significant for both males and females revealing that the dental development process is similar. © 2019 Elsevier B.V. All rights reserved. 1. Introduction The age estimation methods have a wide range of applications in archeology, anthropology, forensic sciences, pediatrics, ortho- pedics, orthodontics and pediatric dentistry. In forensic sciences and legal medicine the age estimation is of greater importance in the identification of deceased victims and for the definition of criminal and legal responsibilities. Defining the social status of minors is crucial in many social fields such as children abandon- ments, adoptions or when determining a refugee status [1]. In age estimation, the most commonly used developmental indicators include skeletal maturity (skeletal age), body height and weight (morphological age), sexual development (sexual age), tooth development and eruption (dental age) [2]. In dentistry, especially in orthodontics, the determination of the dental age (DA) of a patient, both combined with the skeletal age, assists the clinician in developing a proper diagnosis and ideal treatment timing. The dental maturation may be assessed either by the dental eruption stage or by the mineralization stage of teeth and dental buds. Localized conditions, such as crowding, ankylosis, extractions, retention of primary teeth, malpositions, dental trauma, cysts, may influence the timing and the sequence of dental eruption. Many conditions both systemic (prematurity, nutrition, metabolic dysfunctions, anemia, celiac disease) and genetic (Apert syndrome, Neurofibromatosis, Down syndrome) are associated with a pattern of delayed toot eruption [3]. Furthermore, it is not possible to determine the exact time of eruption of each tooth for the same individual. The process of tooth mineralization is less affected by environmental factors and pathological alterations and it can be evaluated at any time during the calcification process. For these reasons, the radiological evaluation of dental development is a more reliable method for age estimation in children compared to dental eruption. Different methods of radiographic assessment of the DA have been proposed, either focusing on the qualitative aspect of the tooth calcification or on the shape of developing tooth parts [4–9]. Demirjian et al. [7] defined 8 tooth mineralization stages according to the shape of each permanent left mandibular teeth * Corresponding author at: Via San Vitale 59, 40125 Bologna, Italy. E-mail address: simone.bagattoni2@unibo.it (S. Bagattoni). https://doi.org/10.1016/j.forsciint.2019.03.015 0379-0738/© 2019 Elsevier B.V. All rights reserved. Forensic Science International 298 (2019) 336–340 Contents lists available at ScienceDirect Forensic Science International journal homepage: www.elsevier.com/locate/forsciint