Journals / Journal of Health Sciences and Medicine / 2026 / Volume: 9 Issue: 3

Sex-specific linear regression models for age estimation using Cameriere’s third Molar Maturity Index (I3M): a preliminary report from Turkiye

Şehrazat Evirgen(IZMIR TINAZTEPE UNIVERSITY, FACULTY OF DENTISTRY)0000-0001-5760-0531
Isabella Lima Arrais Ribeiro(Federal University of Paraíba)0000-0001-6538-6811
Pages
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Publication Date
2026-05-19
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

However, the moderate explained variance warrants caution, and external validation in an independent Turkish sample is required before routine forensic application.

📌 3 Key Takeaways

🎯
Objective & Hypothesis:Aims: Cameriere’s Third Molar Maturity Index (I3M) is well established for age-threshold determination, yet its application in regression-based age estimation has not been explored in the Turkish population.
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Key Findings & Data:This study aimed to derive sex-specific linear regression models for estimating chronological age from I3M in Turkish adolescents and young adults.
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Conclusion & Impact:However, the moderate explained variance warrants caution, and external validation in an independent Turkish sample is required before routine forensic application.
🔬Design:Lab & Field Experiment
📍Scope:Comprehensive Sample
⚙️Variables:Cameriere’s method · chronological age · dental age

Abstract

Aims: Cameriere’s Third Molar Maturity Index (I3M) is well established for age-threshold determination, yet its application in regression-based age estimation has not been explored in the Turkish population. This study aimed to derive sex-specific linear regression models for estimating chronological age from I3M in Turkish adolescents and young adults. Methods: This retrospective cross-sectional study evaluated 200 digital panoramic radiographs of individuals aged 14-22 years. I3M was quantified on left mandibular third molars using standardized ImageJ-based measurements by a single blinded examiner (ICC=0.90). Linear regression models were constructed for the pooled sample and separately by sex. Results: I3M showed a statistically significant inverse association with chronological age in all models (p<0.001). In the pooled analysis [age=19.04 - 4.24×I3M; B=-4.24, SE=0.33, 95% CI (-4.88, -3.60)], the model accounted for 46.1% of the variance (adjusted R²=45.9%) with a standard error of estimate (SEE) of 1.65 years and a mean absolute error (MAE) of 1.34 years. Sex-stratified models showed comparable performance: females (R²=49.5%, SEE=1.64, MAE=1.36) and males (R²=41.5%, SEE=1.69, MAE=1.31), with no statistically significant difference between models (Chow test p=0.67). Conclusion: This preliminary study presents the first population-specific regression equations for I3M in Turkiye. These models may serve as a complementary forensic tool for age estimation across multiple legally relevant thresholds. However, the moderate explained variance warrants caution, and external validation in an independent Turkish sample is required before routine forensic application.

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Cite This Article

Kahraman, E. N., Evirgen, Ş., Gülşahı, A., Ribeiro, I. L. A., Cameriere, R. (2026). Sex-specific linear regression models for age estimation using Cameriere’s third Molar Maturity Index (I3M): a preliminary report from Turkiye. Journal of Health Sciences and Medicine, Volume: 9 Issue: 3. https://doi.org/10.32322/jhsm.1845868

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References (31)

  1. Shoukath A, Vidigal MTC, Vieira W, Paranhos LR, Mânica S, Franco A. Dental age estimation methods applied to Indian children and adolescents: a systematic review and meta-analysis. Morphologie. 2024; 108(361):100758. doi:10.1016/j.morpho.2023.100758
  2. Vila-Blanco N, Varas-Quintana P, Tomás I, Carreira MJ. A systematic overview of dental methods for age assessment in living individuals: from traditional to Artificial Intelligence-based approaches. Int J Legal Med. 2023;137(4):1117-1146. doi:10.1007/s00414-023-02960-z
  3. Rokhshad R, Nasiri F, Saberi N, et al. Deep learning for age estimation from panoramic radiographs: a systematic review and meta-analysis. J Dent. 2025;154:105560. doi:10.1016/j.jdent.2025.105560
  4. Cameriere R, Ferrante L, De Angelis D, Scarpino F, Galli F. The comparison between measurement of open apices of third molars and Demirjian stages to test chronological age of over 18 year olds in living subjects. Int J Legal Med. 2008;122(6):493-497. doi:10.1007/s00414-008-0279-6
  5. De Luca S, Pacifici A, Pacifici L, et al. Third molar development by measurements of open apices in an Italian sample of living subjects. J Forensic Leg Med. 2016;38:36-42. doi:10.1016/j.jflm.2015.11.007
  6. Pereira CP, Rodrigues A, Augusto D, et al. Forensic age estimation using new models of mathematical regression formula constructed with molar indexes: dental age assessment. J Stomatol. 2021;74(2):95-100. doi:10.5114/jos.2021.106540
  7. Kelmendi J, Cameriere R, Koçani F, Galić I, Mehmeti B, Vodanović M. The Third Molar Maturity Index in indicating the legal adult age in Kosovar population. Int J Legal Med. 2018;132(4):1151-1159. doi:10.1007/s00414-017-1761-9
  8. Gulsahi A, De Luca S, Cehreli SB, Tirali RE, Cameriere R. Accuracy of the third molar index for assessing the legal majority of 18 years in Turkish population. Forensic Sci Int. 2016;266:584.e1-584.e6. doi:10. 1016/j.forsciint.2016.04.034
  9. Akkaya N, Yilanci HÖ. Assessment of Third Molar Maturity Index for legal age threshold of 18 in a sample of Turkish individuals. Austr J Forens Sci. 2021;53(3):314-324. doi:10.1080/00450618.2020.1729412
  10. Arsan B, Şakır M, Büyük C, Fişekçioğlu E, Kurt G. Comparison of Cameriere and Demirjian methods for estimating adulthood in Turkish population. Meandros Med Dent J. 2022;23(3):275-281.
  11. Çakan KN. Comparison of the Cameriere’s third molar maturity index and Olze et al.’s stages of radiographic visibility of the root pulp in a Turkish population. Eur Oral Res. 2024;58(2):88-94. doi:10.26650/eor. 20241231589
  12. Uğuz HN, Çelik Öge S. Comparison of applicability of the London Atlas technique and Cameriere’s Third Molar Maturity Index (I3M) in determining the age threshold of 18 years in Turkish population. Selcuk Dent J. 2022;9(2):428-434. doi:10.15311/selcukdentj.1060239
  13. Akman H, Surme K, Cimen T, Ayyildiz H. Accuracy of different dental age estimation methods for determining the legal majority of 18 years in the Turkish population. Clin Oral Investig. 2022;26(6):4537-4547. doi: 10.1007/s00784-022-04417-w
  14. Turkish Penal Code, Law No. 5237, Official Gazette No. 25611 (2004).
  15. Turkish Child Protection Law, Law No. 5395, Official Gazette No. 25876 (2005).
  16. Regulation on the Execution of Sentences and Security Measures, Decision No. 2006/10218 (2006).
  17. Shen S, Yuan X, Wang J, Fan L, Zhao J, Tao J. Evaluation of a machine learning algorithm for predicting the dental age of adolescents based on different preprocessing methods. Front Public Health. 2022;10:1068253. doi:10.3389/fpubh.2022.1068253
  18. Valenzuela A, Martin-de las Heras S, Marques T, Exposito N, Bohoyo JM. The application of dental methods of identification to human burn victims in a mass disaster. Int J Legal Med. 2000;113(4):236-239. doi:10.1007/s004149900099
  19. UNICEF. Humanitarian Action for Children (HAC): Turkiye. Available from: https://www.unicef.org/turkiye/en/humanitarian-action-children-hac. Accessed 21 Mar 2026.
  20. Tibet EE. Escaping exclusion. Confused moralities and Syrian unaccompanied minors’ search for freedom in Turkiye. Movement J Critic Migrat Border Regime Stud. 2017;3:2.
  21. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344-349. doi:10.1016/ j.jclinepi.2007.11.008
  22. Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*power 3.1: tests for correlation and regression analyses. Behav Res Methods. 2009;41(4):1149-1160. doi:10.3758/BRM.41.4.1149
  23. Cohen J. Statistical Power Analysis for the Behavioral Sciences. Rev. ed. Lawrence Erlbaum Associates; 1988.
  24. Ferrante L, Cameriere R. Statistical methods to assess the reliability of measurements in procedures for forensic age estimation. Int J Legal Med. 2009;123:277-283. doi:10.1007/s00414-009-0349-4
  25. Giannitto N, Militi A, Sapienza D, et al. Application of Third Molar Maturity Index (I3M) for assessing adult age of 18 years in a Southern Italian population sample. Eur J Dent. 2023;17(1):200-209. doi:10.1055/ s-0042-1744373
  26. Balla SB, Lingam S, Kotra A, et al. New regression models for dental age estimation in children using Third Molar Maturity Index: a preliminary analysis testing its usefulness as reliable age marker. Leg Med (Tokyo). 2019;39:35-40. doi:10.1016/j.legalmed.2019.06.003
  27. Nyström M, Aine L, Peck L, Haavikko K, Kataja M. Dental maturity in Finns and the problem of missing teeth. Acta Odontol Scand. 2000;58(2): 49-56. doi:10.1080/000163500429280
  28. Trakiniėnė G, Andriuškevičiūtė I, Šalomskienė L, Vasiliauskas A, Trakinis T, Šidlauskas A. Genetic and environmental influences on third molar root mineralization. Arch Oral Biol. 2019;98:220-225. doi: 10.1016/j.archoralbio.2018.11.026
  29. International Organization for Forensic Odonto-Stomatology (IOFOS). Recommendations for Quality Assurance: Dental Age Estimation. 2018. Available from: https://iofos.eu/wp-content/uploads/2022/12/Age_estimation_final.pdf Accessed 21 Mar 2026.
  30. Celikoglu M, Miloglu O, Kazanci F. Frequency of agenesis, impaction, angulation, and related pathologic changes of third molar teeth in orthodontic patients. J Oral Maxillofac Surg. 2010;68(5):990-995. doi:10.1016/j.joms.2009.07.063
  31. Ritz-Timme S, Cattaneo C, Collins MJ, et al. Age estimation: the state of the art in relation to the specific demands of forensic practise. Int J Legal Med. 2000;113(3):129-136. doi:10.1007/s004140050283