Consistency between Undergraduate and Graduate Students using Two Dental Staging Systems — A Pilot Study

Roberta Pinto; Maria Eduarda Causs; Débora Moreira; Nikolaos Angelakopoulos; Ademir Franco

doi:10.14710/actodont.33953

DOI: https://doi.org/10.14710/actodont.33953

Consistency between Undergraduate and Graduate Students using Two Dental Staging Systems — A Pilot Study

Roberta Pinto¹, Maria Eduarda Causs¹, Débora Moreira², Nikolaos Angelakopoulos^{3, 1} , Ademir Franco^{1, 4}

¹Division of Forensic Dentistry, Faculdade São Leopoldo Mandic, Brazil

²Division of Oral Radiology, Faculdade São Leopoldo Mandic, Brazil

³Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Switzerland

⁴ Department of Therapeutic Stomatology, Institute of Dentistry, Sechenov University, Russian Federation

View all affiliations

Received: 29 Jul 2026; Revised: 25 Aug 2026; Accepted: 31 Aug 2026; Available online: 25 Sep 2026; Published: 1 Dec 2026.

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

BibTex Citation Data :

@article{actodont33953,
    author = {Roberta Pinto and Maria Eduarda Causs and Débora Moreira and Nikolaos Angelakopoulos and Ademir Franco},
    title = {Consistency between Undergraduate and Graduate Students using Two Dental Staging Systems — A Pilot Study},
    journal = {Acta Odontologica Indonesia},
  volume = {0},
    number = {0},
    year = {2026},
    keywords = {Age,  Dental, Forensic dentistry, Radiograph, Reproducibility},
    abstract = { Radiographic dental staging remains one of the most frequently applied approaches for subadult dental age assessment in forensic odontology. In this preliminary study, we compared the consistency across observers with different academic level applying two staging systems. Methods: Forty-six participants composed four groups according to academic level: undergraduate (n = 16), specialization (n = 13), master’s (n = 10), and doctoral students (n = 7). Each participant assessed 10 panoramic radiographs from individuals aged 6.5–13.5 years (mean: 9.45 ± 2.45 years), staging seven left permanent mandibular teeth (International Dental Federation: 31–37) using both Demirjian’s and Moorrees’ systems. A total of 920 radiographic assessments and 6,440 dental stage allocations were generated. Observer consistency was assessed separately for each tooth, staging system, and academic level-based group using weighted Fleiss’ kappa coefficients with ordinal weights and 95% confidence intervals. Results: Staging performance using Demirjian’s and Moorrees’ systems by observers with different academic levels showed similar consistency. Absolute differences between systems remained below 0.10 in 92.9% of the comparisons. Teeth 31 and 36 generally presented the lowest consistency estimates across staging systems and observer groups, whereas tooth 34 frequently showed among the highest consistency values. Despite the discrete differences, the largest absolute differences between Demirjian's and Moorrees' systems varied according to the observers' educational background, being more evident for teeth 31, 36, and 37, while the remaining teeth showed even more discrete differences between staging systems. Conclusion: Despite the discrete differences observed between staging through Demirjian’s and Moorrees’ systems, the results of this study should be carefully interpreted since it presented a preliminary point-specific assessment of consistency and not accuracy. Future studies should implement comparisons with gold standard observers and with chronological age to enable accuracy estimates. },
   issn = {3090-7411},   pages = {49--60}  doi = {10.14710/actodont.33953},
    url = {https://ejournal2.undip.ac.id/index.php/actodont/article/view/33953}
}

Citation Format:

Abstract

Radiographic dental staging remains one of the most frequently applied approaches for subadult dental age assessment in forensic odontology. In this preliminary study, we compared the consistency across observers with different academic level applying two staging systems. Methods: Forty-six participants composed four groups according to academic level: undergraduate (n = 16), specialization (n = 13), master’s (n = 10), and doctoral students (n = 7). Each participant assessed 10 panoramic radiographs from individuals aged 6.5–13.5 years (mean: 9.45 ± 2.45 years), staging seven left permanent mandibular teeth (International Dental Federation: 31–37) using both Demirjian’s and Moorrees’ systems. A total of 920 radiographic assessments and 6,440 dental stage allocations were generated. Observer consistency was assessed separately for each tooth, staging system, and academic level-based group using weighted Fleiss’ kappa coefficients with ordinal weights and 95% confidence intervals. Results: Staging performance using Demirjian’s and Moorrees’ systems by observers with different academic levels showed similar consistency. Absolute differences between systems remained below 0.10 in 92.9% of the comparisons. Teeth 31 and 36 generally presented the lowest consistency estimates across staging systems and observer groups, whereas tooth 34 frequently showed among the highest consistency values. Despite the discrete differences, the largest absolute differences between Demirjian's and Moorrees' systems varied according to the observers' educational background, being more evident for teeth 31, 36, and 37, while the remaining teeth showed even more discrete differences between staging systems. Conclusion: Despite the discrete differences observed between staging through Demirjian’s and Moorrees’ systems, the results of this study should be carefully interpreted since it presented a preliminary point-specific assessment of consistency and not accuracy. Future studies should implement comparisons with gold standard observers and with chronological age to enable accuracy estimates.

Fulltext View|Download Email colleagues

Keywords: Age, Dental, Forensic dentistry, Radiograph, Reproducibility

Article Metrics:

Article Info

Section: Original Research

Language : EN

In 2026: December Edition (Article in Press)

Dursun D, Geçer RB. Dental age estimation from panoramic radiographs: A comparison of orthodontist and ChatGPT-4 evaluations using the London Atlas, Nolla, and Haavikko methods. Diagnostics (Basel) 2025; 15(18): 2389. https://doi.org/10.3390/diagnostics15182389
Mohamed EG, Díaz Redondo RP, Koura A, EL-Mofty MS, Kayed M. Dental age estimation using deep learning: a comparative survey. Computation 2023; 11(2): 18. https://doi.org/10.3390/computation11020018
Baumann P, Widek T, Merkens H, Boldt J, Petrovic A, Urschler M, et al. Dental age estimation of living persons: Comparison of MRI with OPG. Forensic Sci Int 2015; 253: 76-80. https://doi.org/10.1016/j.forsciint.2015.06.001
Franco A, Murray J, Heng D, Lygate A, Moreira D, Ferreira J, et al. Binary decisions of artificial intelligence to classify third molar development around the legal age thresholds of 14, 16 and 18 years. Sci Rep 2024; 14(1): 4668. https://doi.org/10.1038/s41598-024-55497-5
Nolla CM. The development of permanent teeth. J Dent Child 1960; 27(4): 254-66
Moorrees CF, Fanning EA, Hunt EE Jr. Age variation of formation stages for ten permanent teeth. J Dent Res 1963; 42: 490-502
Demirjian A, Goldstein H, Tanner JM. A new system of dental age assessment. Hum Biol 1973; 45(2): 211-27
Köhler S, Schmelzle R, Loitz C, Püschel K. Development of wisdom teeth as a criterion of age determination. Ann Anat 1994; 176(4): 339-45
Gleiser I, Hunt EE Jr. The permanent mandibular first molar: its calcification, eruption and decay. Am J Phys Anthropol 1955; 13(2): 253-83. https://doi.org/10.1002/ajpa.1330130206
Nicodemo RA, Moraes LC, Médici Filho E. Tabela cronológica da mineralização dos dentes permanentes entre brasileiros. Rev Fac Odontol São José dos Campos 1974; 3(1): 55-6
AlQahtani SJ, Hector MP, Liversidge HM. Brief communication: the London atlas of human tooth development and eruption. Am J Phys Anthropol 2010; 142(3): 481-90. https://doi.org/10.1002/ajpa.21258
Esan TA, Yengopal V, Schepartz LA. The Demirjian versus the Willems method for dental age estimation in different populations: A meta-analysis of published studies. PLoS One 2017; 12(11): e0186682. https://doi.org/10.1371/journal.pone.0186682
Boedi RM, Angelakopoulos N, Franco A, Polukhin N, Kumagai A, Galic I, et al. Evaluation of Demirjian staging method reproducibility and reliability for dental age estimation between eight forensic experts. Int J Legal Med 2025; 139(6): 2883-90. https://doi.org/10.1007/s00414-025-03560-9
Franco A, Moreira DD, Cidade R, Machado M, Bueno J, Malschitzky C, Boedi RM. The Brazilian (FRANCO) method for dental age estimation: Willems' model revisited. Clin Oral Investig 2024; 28(9): 495. https://doi.org/10.1007/s00784-024-05869-y
American Dental Association. ADA technical report no. 1077 for human age assessment by dental analysis; American Board of Forensic Odontology standards and guidelines for dental age assessment. Chicago: American Dental Association; 2020. Available from: https://abfo.org
Enhancing the Quality and Transparency of Health Research. EQUATOR network. Available at: https://www.equator-network.org/
World Medical Association. World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Participants. JAMA. 2025;333(1):71–74. doi: 10.1001/jama.2024.21972
Banar N, Bertels J, Laurent F, Boedi RM, De Tobel J, Thevissen P, et al. Towards fully automated third molar development staging in panoramic radiographs. Int J Legal Med 2020; 134(5): 1831-41. https://doi.org/10.1007/s00414-020-02283-3
Shi Y, Ye Z, Guo J, Tang Y, Dong W, Dai J, et al. Deep learning methods for fully automated dental age estimation on orthopantomograms. Clin Oral Investig 2024; 28(3): 198. https://doi.org/10.1007/s00784-024-05598-2
Mohammad N, Ahmad R, Gaus MHA, Kurniawan A, Yusof MYPM. Accuracy of automated forensic dental age estimation lab (F-DentEst Lab) on large Malaysian dataset. Forensic Sci Int 2024; 361: 112150. https://doi.org/10.1016/j.forsciint.2024.112150
Akshaya M, Vijayalakshmi KR, Kumar TNR, Rakshana M. Automated dental age estimation model for panoramic radiographs. J Forensic Leg Med 2026; 120: 103148. https://doi.org/10.1016/j.jflm.2026.103148
Demirjian A, Goldstein H. New systems for dental maturity based on seven and four teeth. Ann Hum Biol 1976; 3(5): 411-21. https://doi.org/10.1080/03014467600001671
Angelakopoulos N, Boedi RM, De Luca S, et al. Does increased staging complexity influence expert agreement in dental age estimation?. Int J Legal Med (2026). https://doi.org/10.1007/s00414-026-03946-3
Perschbacher S. Interpretation of panoramic radiographs. Aust Dent J 2012; 57(Suppl 1): 40-5. https://doi.org/10.1111/j.1834-7819.2011.01655.x
Patano A, Malcangi G, Inchingolo AD, Garofoli G, De Leonardis N, Azzollini D, et al. Mandibular crowding: Diagnosis and management—A scoping review. J Pers Med 2023; 13(5): 774. https://doi.org/10.3390/jpm13050774
Franco A, Vetter F, Coimbra EF, Fernandes Â, Thevissen P. Comparing third molar root development staging in panoramic radiography, extracted teeth, and cone beam computed tomography. Int J Legal Med 2020; 134(1): 347-53. https://doi.org/10.1007/s00414-019-02206-x
Valente RPA, Ribeiro JMC, Sakamoto SPS, Rodrigues R, Franco A, Paranhos LR. Survey on the dental age estimation practice among Brazilian experts. Observ Latinoam Econ 2024; 22(3): e3806. https://doi.org/10.55905/oelv22n3-138
Franceschetti L, Merelli VG, Corona S, Magli F, Maggioni L, Cummaudo M, et al. Analysis of interrater reliability in age assessment of minors: how does expertise influence the evaluation? Int J Legal Med 2022; 136(1): 279-285. https://doi.org/10.1007/s00414-021-02707-8

Last update:

No citation recorded.

Last update:

No citation recorded.

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Authors who publish in Acta Odontologica Indonesia retain full copyright ownership of their work. In keeping with the journal’s commitment to open access, all articles are published under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).

This license permits anyone to access, use, share, adapt, remix, transform, and build upon the work for any non-commercial purpose, provided that appropriate credit is given to the original author(s), a link to the license is provided, and any changes to the work (if any) are clearly indicated.

Authors' Rights

Authors retain the right to reuse their published article in future scholarly works (such as books or conference presentations). All such uses must comply with the terms of the CC BY-NC license. Authors are encouraged to disseminate their work as widely as possible.

Readers' Rights

Readers and third parties may use the content in accordance with the CC BY-NC license. This includes the ability to reproduce, modify, and build upon the article for non-commercial purposes, as long as proper attribution is given.