Third molar maturity index (I3M) assessment according to different geographical zones: a large multi-ethnic study sample.

Identification of living undocumented individuals highlights the need for accurate, precise, and reproducible age estimation methods, especially in those cases involving minors. However, when their country of origin is unknown, or it can be only roughly estimated, it is extremely difficult to apply assessment policies, procedures, and practices that are accurate and child-sensitive. The main aim of this research is to optimize the correct classification of adults and minors by establishing new cut-off values for four different continents (Africa, America, Asia, and Europe). For this purpose, a vast sample of 10,701 orthopantomographs (OPTs) from four continents was evaluated. For determination and subsequent validation of the new third molar maturity index (I3M) cut-off values by world regions, a cross-validation by holdout method was used and contingency tables (confusion matrices) were generated. The lower third molar maturity indexes, from both left and right side (I3ML and I3MR) and the combination of both sides (I3ML_I3MR) were calculated. The new cut-off values, that aim to differentiate between a minor and an adult, with more than 74.00% accuracy for all populations were as follows (I3ML; I3MR; I3ML_I3MR, respectively): Africa = (0.10; 0.10; 0.10), America = (0.10; 0.09; 0.09), Asia = (0.15; 0.17; 0.14), and Europe = (0.09; 0.09; 0.09). The higher sensitivity (Se) was detected for the I3ML for male African people (91%) and the higher specificity (Sp) of all the parameters (I3ML; I3MR; I3ML_I3MR) for Europeans both male and female (> 91%). The original cut-off value (0.08) is still useful, especially in discriminating individuals younger than 18 years old which is the goal of the forensic methods used for justice.

Examination of the radiographic visibility of the root pulp of the mandibular second molars as an age marker.

Forensic odontologists often confront with conceptually simple medicolegal question of whether an individual is a juvenile or an adult. The demand for additional research into extending dental age estimation methods in late adolescence is never the less, especially in those who have passed 15 years and are suspected older than 18 years. The present research investigated the regressive dental characteristic, i.e. radiographic visibility of the root pulp in mandibular second molars for the purpose of age assessment, especially for determining the age over 18 years. Nine hundred thirty-six orthopantomograms comprised of 436 males and 500 females aged from 14 to 22 years were examined. Descriptive statistics were performed for each stage in both sexes. The correlation statistics revealed that there is a strong, positive correlation between the chronological age and root pulp visibility stages. The analysis revealed that stage 0 occurred first at the age of 14 years in both sexes. Stage 1 first occurred at the age of 14.26 years in females and 14.74 years in males. Stage 2 was first achieved at the age of 18.6 and 15.2 years in males and females, respectively. The suitability of the studied characteristics in mandibular second molars for age estimation could be confirmed but of limited value. The presence of this stage 2 root pulp visibility in male subjects represents a potential criterion for indicating the age over 18 years. In future studies, the pattern of secondary dentin formation in other tooth types should be investigated.

Preliminary analysis testing the accuracy of radiographic visibility of root pulp in the mandibular first molars as a maturity marker at age threshold of 18 years.

Forensic age estimation, after completion of third molar mineralization, regressive features such as apposition of secondary dentin, which is seen as narrowing of the pulp space in the radiographs, can be used as an alternative. In the present study, we explored the radiographic visibility of the root pulp of mandibular first molars using stage classification of Olze et al. (Int J Legal Med 124(3):183-186, 2010) in a sample of 901 orthopantomograms (404 males and 497 females) of south Indian origin with age ranging from 14 to 22 years. Descriptive statistics for the stages according to age was performed for both sexes separately. The strength and direction of the relationship between the chronological age and pulp visualization stages was tested using spearman's rho correlation statistics. The relationship between age and stage attainment showed statistical significance for both sexes. A strong, positive correlation was seen between the stage and chronological age. All males and females presenting stage 0 of root pulp visibility were younger than 18 years. If stage 1 is determined, it is highly possible that an individual regardless of sex is younger than 18 years. Stage 2 was attained in 79.6% males and 83.1% females who were at least 18 years. One hundred percent males and 92.8% females with stage 3 were at least 18 years. The accuracy of this method in mandibular first molars for estimating age threshold of 18 years ranged from moderate to high. However, it is recommended to use this method in conjunction with other age estimation methods.

Evaluating legal age of 18 years through observation of third molars using Gambier et al. method in an orthopantomographic sample of subadults from South India.

In forensic practice, medicolegal physicians are often tasked with estimating age using dental evidence. This calls for an uncomplicated, reliable, and reproducible method for dental age estimation, enabling physicians to proceed without specific odontological expertise. Among various dental methods, third molar eruption analyses are less complicated and easier to perform. In our study, we explored the effectiveness of Gambier et al.'s scoring system, which examines the eruption of all third molars. We retrospectively analysed 1032 orthopantomograms (528 males and 504 females) of individuals aged between 15 and 24 years. The mean chronological age increased with the progression of stages (1 to 3) and phases (A to D) of the third molar eruption for both sexes. In terms of stages, none showed significant discrimination between minors (<18 years) and adults (>18 years), especially for males. However, Gambier's phase D displayed a relatively high likelihood of being 18 years or older, with an overall 85.9 % of males and 95.7 % of females having all third molars in stage 3 being 18 years or older. While the tested method could be helpful in indicating the completion of the 18th year of life, caution is advised (due to a high percentage of false positives), and it should be used alongside other age assessment methods by experts.

A test to study the influence of impaction on mandibular third molar development and forensic age estimation in a sample of south Indian children and young adults.

It has been argued that the impaction of the third molars could result in delayed maturation, which, in turn, could affect age estimations in criminal proceedings. In view of this, the present study was undertaken to determine whether the impaction status could delay the chronological process of third molar mineralization in a sample of south Indian children and young adults. The orthopantomograms (OPGs) of 915 children and young adults of south Indian origin aged between 15 and 22 years were evaluated. Mineralisation stage and impaction status were determined for all lower third molars. Descriptive statistics were performed at stages D to H of Demirjian staging system. The results of independent t-test show that the impaction resulted in statistically significant slower mineralization in impacted lower third molars at stages D to F in both sexes. It was ascertained that the mean ages with the impacted lower third molars at stage G were 0.98-1.38 years higher in males and 0.50-0.80 years higher in females than those with non-impacted lower third molars. For stage H, the mean ages were 0.14-0.21 years higher in males and 0.25-0.44 years higher in females. The probabilities of being 18 years and above is higher for non-impacted lower third molars at stages G and H than those with impacted ones. It is concluded that the impaction could result in delayed maturation in the lower third molars of the studied sample. Further studies are warranted in a more diverse sample.

Premolar maturity index (IPM) for indicating legal age 12 years in a sample of south Indian children - A digital pantomographic study.

Legal age of 12 years has been set as the minimum age of criminal responsibility in many countries. This paper concerned a method for predicting the legal age 12 years based on the maturation of lower first and second premolars. The sample consisted of 900 digital pantomographs of south Indian children (450 males, 450 females) aged between 8 and 16 years. Among them, 580 DPTs were used as test sample and 320 DPTs as validation sample. New cut-offs at the age threshold 12 years were determined by using the measurement of open apices in first premolars (IPM1 < 0.10), second premolars (IPM2 < 0.14) and the combined method (IPM1 + IPM2 < 0.12). The sensitivity (Se), specificity (Sp) and posttest probability (PTP) were established. For IPM1 < 0.10, the Se, Sp and PTP were 92.4 %, 91.3 % and 91.1 % for males and 90.8 %, 87 % and 86.5 % for females. For IPM2 < 0.14, they were 92.6 %, 93.6 % and 93.4 % for males and 91.5 %, 83.1 % and 83.4 % for females. And, for the combined predictor (IPM1 + IPM2 < 0.12), these values were 92.6 %, 94.8 % and 94.6 % and 90.5 %, 84.9 % and 84.7 % in males and females respectively. The best score of positive predictive value and specificity was obtained for males with the combined predictor (IPM1 + IPM2 < 0.12) and with single predictor (IPM1 < 0.10) for females. To conclude, the combined predictor has resulted in better discrimination in males, while in females the single predictor (IMP1 < 0.10) did slightly better. Further studies are warranted to test the combination of dental and skeletal indicators for the prediction of 12 years in the studied population.

Is there any difference in the development of mandibular third molars according to the type of impaction: An orthopantomographic study in south Indian children and adolescents.

Development of third molars and their influence on the dental arch is a major concern in clinical dentistry especially, orthodontics and oral surgery. Lately, their position, eruption potential and development has become a subject of interest in forensic practice. The present study was aimed to determine whether if there is any difference in the development of the mandibular third molars according to the impaction type. Orthopantomographs (n = 1112) from 478 males and 634 females between 15 and 22 years old were analysed. In each radiograph, impaction status and the developmental stage of mandibular third molars were determined. Descriptive statistics were performed at developmental stages D to H. For stage G, there was a delay by 0.74 and 0.62 years for mesioangular impaction, 0.89 and 0.33 years for horizontal impaction, 1.43 and 0.9 years for distoangular impaction and 1.74 and 1.1 years for vertical impaction, in males and females. For stage H, delay by 0.17 and 0.74 years, 0.05 and 0.06 years, 0.48 and 1.48 years and 0.62 and 0.62 years, respectively for all impaction variants in both sexes. Mean chronological age of the distoangular and vertically impacted mandibular third molars were higher in certain developmental stages than mesioangular and horizontal impactions. Our findings concluded that distoangular and vertical impaction variants mineralize more slowly than mesioangular and horizontal variants, however these differences were smaller. Therefore, no distinction is required between impaction types for dental age estimation especially in the prediction of the age of majority (18 years).

Measurement of the open apices of mandibular first and second premolars to test the chronological age over 14 years: Study on a sample of south Indian children.

Age estimation is an integral part of forensic medical and dental practice. In many countries, the age threshold of 14 years is set to determine the minimum age for criminal responsibility. In the present study, the authors studied the final maturation of the first (IPM1) and second mandibular premolars (IPM2) by Cameriere maturity index and determined cut-offs at the age threshold of 14 years, and validate on the test sample. Orthopantomograms of 960 healthy south Indian children and sub-adults (480 boys and 480 girls) aged between 10 and 18 were analysed, 640 as training sample and 320 as a test sample. The results of logistic regression analysis with age (

Above or below 14 years? An orthopantomographic study based on chronological course of eruption of mandibular premolars and second molars in a sample of south Indian children.

In the context of dental age assessment, two significant factors can be studied; tooth mineralisation and tooth emergence. Little is known about the role of a second molar eruption in forensic age estimation. This paper aims to contribute to forensic age estimation using an age threshold of 14 years, studying the eruption stages of permanent mandibular premolars and second molars. Totally 640 orthopantomograms (OPGs) of south Indian children, aged between 10 and 18 years, were evaluated using Olze et al. staging of tooth eruption stages (A-D). Spearman's rho correlation showed a strong, positive, and statistically significant correlation between the chronological age and the eruption stages of both sexes' teeth. Accuracy, sensitivity, specificity, likelihood ratios, and post-test probability values were calculated for all tested teeth. The best performance to discriminate individuals above or below 14 years showed stage D in second molars. The sensitivity varied between 89% and 94% and specificity between 75% and 84%, respectively. Receiver operating characteristic curve analysis revealed high diagnostic performance for stage D, with area under the ROC curve (AUC) values of 84% and 85% for tooth 37 and 85% and 83% for tooth 47 in males and females, respectively. In conclusion, it is possible to predict age over 14 years in south Indian children using tooth emergence stages from OPGs with a relatively high interobserver agreement and good diagnostic accuracy. However, there are some limitations and, therefore, must be used in conjunction with other methods.

Insight into status of dental caries vaccination: A review.

Despite advances in the 21st century, dental caries still remains to be one of the most common infectious diseases. Its prevalence was confirmed by the World Health Organization and affirms dental caries as a major health problem in all over the world. Even though the process of tooth decay is multifactorial, the oral bacteria, mutans streptococci, such as Streptococcus mutans and Streptococcus sobrinus, are considered to be causative agents of dental caries in human. Numerous studies carried out on animals and various categories of vaccines were developed such as whole cell vaccine, subunit vaccine, and synthetic peptides. Irrespective of success from active and passive immunization based on animal trials, it is the phenomenon of human heart reactivity that limited the applicability of these trials in humans. Continuous efforts are being made to overcome these limitations and for further success in human trials. With the advent of various antibodies against antigens of mutans streptococci, local passive immunization has become the safer approach in humans against the colonization of bacteria and caries induction. This review provided insight into epidemiology, active and passive immunization in both animal and human trials, as well as the prospects of caries vaccination.

Discriminatory ability of cervical vertebral maturation stages in predicting attainment of the legal age threshold of 14 years: A pilot study using lateral cephalograms.

PURPOSE: In India, the age of 14 years is the legal age threshold for child labour. Therefore, in suspected instances of child labour, age assessment plays a crucial role in determining whether a violation of the law on the employment of children has occurred. The aim of this retrospective cross-sectional study was to assess the discriminatory ability of stages of cervical vertebral maturation (CVM) in predicting the legal age threshold of 14 years. MATERIALS AND METHODS: Routinely taken lateral cephalograms from 408 subjects aged 10 to 18 years were evaluated retrospectively using the CVM stages described by Baccetti et al. Descriptive statistics, accuracy, sensitivity, specificity, positive and negative predictive values, and likelihood ratios were calculated for stages 2, 3, and 4 of CVM. RESULTS: Real age increased as the CVM stage gradually increased. The results of 2×2 contingency tables showed that CVM stage 4 produced an accuracy of 71% and 73%, a false positive rate of 7% and 18%, and a post-test probability of 59% and 68% for boys and girls, respectively. CONCLUSION: Based on these findings, it can be concluded that the stages of CVM are of limited use for predicting the attainment of the legal age threshold of 14 years. Future studies should investigate whether combinations of skeletal and dental methods could achieve better accuracy and post-test probability.

Evaluation of secondary dentin deposition in lower first molars to indicate a legal age threshold of 14 years using receiver operating characteristic curves.

The age threshold of 14 years has become vital in proving legal violations involving children, particularly in cases of suspected child labour, child pornography and the minimum age of criminal responsibility. In recent years, there has been great interest in the evaluation of age in children and sub-adults using analysis of regressive changes in teeth, with a particular focus on age thresholds that are of medico-legal importance. This research aimed to compare the sensitivity and specificity of stages of root pulp visibility by Olze et al. in a sample of South Indian children aged between 12 and 16 years, with an age threshold of 14 years, using receiver operating characteristic curves and the area under the curve (AUC). Among the four stages of root pulp visibility, stage 2 showed the highest AUC in both female and male cohorts. For stage 2, lower sensitivity and higher specificity values were recorded, indicating the possibility of type II errors (i.e. false negatives). In both sexes, stage 2 had a higher AUC (i.e. 0.696 in females and 0.706 in males, respectively). Based on our findings, it can be concluded that this staging method in lower first molars is of limited value in indicating the legal age threshold of 14 years. Future research should validate the proposed approach in a larger sample and consider how to improve predictions in this area.

Validation of Cameriere's third molar maturity index alone and in combination with apical maturity of permanent mandibular second molar for indicating legal age of 14 years in a sample of South Indian children.

The aims of the present study were to validate the discriminatory potential of Cameriere's third molar maturity index (I3M) cut-off value of I3M < 1.1 and whether closed apices of permanent second mandibular molar (I2M = 0.0) and I3M < 1.1 indicate the legal age of 14 years and older. A digital orthopantomograms of 804 healthy South Indian children, aged between 10 and 18 years, were collected retrospectively, and mineralization of the third and second left mandibular molars was analyzed by Cameriere's method. The proportion of accurately classified (Ac) individuals using the cut-off value of I3M < 1.1 was 79.4% for males, with Bayes post-test probability (Bayes PTP) of 68.8%. For females, Ac was 79.9% and Bayes PTP was 70.9%. The sensitivity was 94.8% and 98.2% for males and females, and the specificity was 58.7% and 62.8%, respectively. The combination of both variables, I3M < 1.1 and I2M = 0.0, increased the Ac to 87.2% and 94.4% in males and females, the specificity to 98.6% and 99.2%, and Bayes PTP to 98.2% and 94.4%, respectively. In conclusion, the suggested cut-off value of I3M < 1.1 is of moderate accuracy in discriminating individuals between 14 years or older from those under 14 years in the studied population. A combination of both variables, I2M = 0.0 and I3M < 1.1, the discriminating test achieves an excellent specificity and Bayes PTP, which is mandatory for the forensic and medicolegal purposes.

Quantification of Mycobacterium tuberculosis and Mycobacterium avium complex in human immunodeficiency virus-infected individuals with and without tuberculosis.

CONTEXT: For a dental practitioner, HIV-TB co-infection which is a lethal aliment is an occupational hazard by the virtue of abundant aerosol formation in day to day dental practice. AIM: To assess the prevalence of TB co-infection among HIV patients. To assess the infectivity by culturing Mycobacterium Tuberculosis and Mycobacterium avium complex using Lowenstein Jensen medium and Middlebrook medium. SETTING AND DESIGN: One hundred and forty one recently diagnosed HIV seropositive patients were selected. They were divided into two group based on their clinical symptomatology. Sputum samples, CD4 counts and brief case history were collected from these patients. SUBJECTS AND METHODS: Sputum samples were homogenized using modified Petroff 's method. The samples were cultured using Lowenstein Jensen and Middlebrook media. Cultures were interpreted after two weeks of incubation and the cultures were quantified based on their number of colonies produced on them. STATISTICAL ANALYSIS: Descriptive statistical analyses followed by Chi square test were performed to assess the prevalence and variation of TB co-infection. RESULTS: Prevalence of TB in our sample is 25.53%. Higher CFU of MTB and MAC are obtained in patients symptomatic for TB. MB yields higher CFU than LJ. CONCLUSION: Clinical symptoms alone cannot act as basis for suspecting TB in HIV patients. Mycobacterial cultures should be used as diagnostic aids and preferably both the mediums have to be used.

Forensic age estimation of 85 male child laborers and 31 rescued female commercial sex workers from Hyderabad in South India.

Age estimation in living individuals has attained importance in forensic sciences from legal proceedings and has been a frequent request from concerned authorities to ascertain whether the person in question has reached the age of imputability and legal responsibility. The purpose of age estimation is not just limited to juvenile or sub-adult delinquents but also required in situations like a violation of child rights such as child employment, commercial sexual exploitation involving minor girls. Indian Law strictly forbids any employment of the children under the age of 14 and sexual exploitation of minor girls (<18 years). In this study, we assessed the skeletal and dental ages and correlate to reported chronological ages in a sample of 85 male child labourers and 31 female commercial sex workers. Statistical analysis of the results was performed to verify the similarities or differences between reported and biological age. The results had revealed a statistically significant difference between the reported age, skeletal, dental, and calculated biologic age (p < 0.05). The results indicate the need to establish a more reliable method for determining the biological age in an age-specific population.

Applicability of Cameriere European formula for age estimation of 10-15 years legal threshold in South Indian population.

AIM: The aim of the present study is to assess the relationship between chronological age (CA) and the measurement of the open apices in teeth and also assess the accuracy of Cameriere methods on dental age (DA) estimation in the South Indian population. SUBJECTS AND METHODS: A sample of 200 orthopantomographs of children aged between 10 and 15 years were collected. The seven left permanent mandibular teeth were evaluated with Cameriere method. RESULTS: Regression analysis was carried out which derived the following linear regression formula: Age = 14.117 - 0.01 g - 1.732W3 + 0.016N0 - 0.289 × 5 - 0.099.s. N0. The equation explained 88.3% (R 2 = 0.883) of the total deviance. The accuracy of the European formula and South Indian formula was determined by the difference between the estimated DA and CA. Cameriere formula produced 32% and 18% of absolute residuals falls within the range of ± 1 and ± 0.5 years, whereas the new regression formula produced 72% and 35% within range of ± 1 and ± 0.5 years. CONCLUSION: This further highlight the importance of population-specific formula keeping in mind about variation in dental maturation across different regions.

Olze et al. stages of radiographic visibility of root pulp and cameriere's third molar maturity index to estimate legal adult age in Hyderabad population.

CONTEXT: Predicting one's attainment of age of majority is a controversial issue and considered as important aspect in medicolegal cases. In India, individuals older than 18 years of age have full capacity regarding civil conduct and are tried as adults for criminal charges. AIMS AND OBJECTIVE: To compare the accuracy of Olze et al., stages of radiographic visibility of root pulp, and Cameriere's third molar maturity index (I 3M < 0.08) to estimate the age of majority. MATERIALS AND METHODS: A total of 615 digital orthopantomographs of children aged between 15 and 22 years. The lower left third molars were evaluated using ImageJ computer software. The effectiveness of both methods was evaluated using sensitivity, specificity, positive likelihood ratios (LR+), and LR negative (LR-). RESULTS: For I 3M < 0.08, the sensitivity, specificity, LR+, LR- were 0.76, 0.72, 2.79, 0.32 and 0.67, 0.76, 2.83, 0.43 in males and females respectively. For Stage 0, the sensitivity, specificity, LR+, LR- were 0.68, 0.86, 5.18, 0.36 and 0.72, 0.91, 8.63, 0.31, respectively. CONCLUSION: Stage 0 of Olze's radiographic root pulp visibility showed to be more accurate than cutoff value of I 3M< 0.08 in discriminating adults and minors of Hyderabad sample when a test of high sensitivity and specificity is required.

New regression models for dental age estimation in children using third molar maturity index: A preliminary analysis testing its usefulness as reliable age marker.

This paper concerns a method to estimate age in children using third molar maturity index (I3M) as independent variable and age as the dependent variable. Total of 1283 digital orthopantomograms (OPTs) of south Indian children aged between 7 and 22 years was included. Training sample of 933 OPTs was used to derive regression formulae, and validation sample of 350 OPTs used to verify accuracy of newly derived regression models. Regression analysis performed revealed that cubic function gave the best correlation between the studied variables. The models exhibited a high correlation coefficient for third molar development in both sexes (0.81 for boys and 0.84 for girls). When new models were verified, slight overestimation of dental age i.e., 0.2 years in boys and 0.13 years in girls was observed. Therefore, we conclude by recommending newly derived regression models as they provided better age predicting performances.

A cut-off value of third molar maturity index for indicating a minimum age of criminal responsibility: Older or younger than 16 years?

Providing appropriate legal mechanisms, that evaluate the progression of development from the age of childhood innocence to maturity and full responsibility, considered one of the difficult areas of criminal justice policy. The minimum age of criminal responsibility (MACR) in children varies among countries and differs widely owing to history and culture. Due to rising and brutality of criminal offenses, particularly by juveniles, few countries have lowered the minimum age of criminal responsibility, and many have considered/considering to do the same. India is one such country in which is under the proposal of lowering the age of criminal responsibility to 16 years. As there is lack of useful age assessment methods, that can indicate whether if the individual in question is younger (<16 years) or older than MACR (≥16 years), the present study was undertaken to derive a specific cut-off value of the third molar maturity index (I3M) for this purpose. The sample consisted of 1078 orthopantomograms (OPTs) from Andhra Pradesh, India, aged between 11 and 20 years (45.4% males and 54.6% females). The reproducibility of I3M was calculated by intra-class correlation coefficients, which showed an intra-rater and inter-rater agreement of 0.912 and 0.891, respectively. The sample was divided into training dataset (819 OPTs), to test I3M and gender as independent variables and MACR as a dependent variable by logistic regression analysis, and test dataset (259 OPTs). A receiver operating curve (ROC) analysis was performed to evaluate the specific cut-off value of I3M for predicting MACR status. A logistic regression analysis showed that gender was not statistically significant for predicting MACR status while ROC analysis indicated a cut-off value of I3M = 0.293 as best for predicting MACR status. The performance of derived cut-off value was tested in a test data set. The sensitivity of the test was 90.6% and 90%, while specificity was 86% and 87.1% in males and females, respectively. The proportion of correctly classified individuals was 88.0% and 88.7% in males and females, respectively. The estimated Bayes post-test probability in males was 87.2% and while in females it was 88.3%. The results highlight the contribution of the derived cut-off value of I3M for discriminating individuals around MACR and should be evaluated in other populations.

Validation of third molar maturity index (I3M) for discrimination of juvenile/adult status in South Indian population.

Deliberate falsification of age was considered to be one of the main reasons for forensic age estimation of the living individuals. This posed to be a challenging task during criminal and legal proceedings, and ultimate care must be taken not to classify juveniles as adults. Third molars are the only developing teeth during late adolescence and early adulthood. Our study was designed to analyze the usefulness of the third molar maturity index (I3M) specific cut-off value (I3M < 0.08) to discriminate adults (≥18 years) and juveniles (<18 years) in South Indian children. 216 panoramic radiographs (114 females and 102 males) of living subjects aged between 14 and 21 years were analyzed. Our results demonstrated high sensitivity (83.3% and 90.2%) and specificity (98.3% and 95.1%) for females and males respectively. The positive likelihood ratios of being adult were 50.00 and 18.35 while the negative likelihood ratios were 0.17 and 0.10 in females and males respectively. The estimated posttest probability was 98.0% in females and 94.8% in males. The obtained results showed that the specific cut-off value of I3M < 0.08 may be a useful additional tool in discrimination of individuals who are around 18 years of age.