Assessment of the Accuracy and Reliability of Three Dental Age Estimation Methods (Demirjian, Willems, and Cameriere) in a North Indian Pediatric Population

Background: Estimation of dental age is essential for pediatric dentistry, orthodontics, forensic odontology, and medico-legal investigation.Because the accuracy of age estimation methods depends on population, each method should be validated within relevant geographic and ethnic groups.This study aimed to assess and compare the accuracy and reliability of the Demirjian, Willems, and Cameriere methods for dental age estimation in a North Indian pediatric population.Materials and methods: A retrospective cross-sectional study was conducted on 600 archived digital orthopantomograms (OPGs) from children aged 6 to 15 years.Chronological age was compared with dental age, which was estimated using the Demirjian, Willems, and Cameriere methods.Accuracy was assessed using the mean estimation error, mean absolute error, intraclass correlation coefficients (ICCs), Bland-Altman analysis, and repeated-measures analysis of variance (ANOVA).Results: The mean chronological age of the study population was 10.73 ± 2.41 years.The Demirjian method significantly overestimated age by 0.58 ± 0.86 years (p < 0.001), while the Willems method showed a smaller overestimation of 0.16 ± 0.69 years (p < 0.001).The Cameriere method underestimated age by 0.07 ± 0.74 years, although the difference was not statistically significant (p = 0.083).The Willems method demonstrated the lowest mean absolute error (0.52 ± 0.46 years) and the highest agreement with chronological age (ICC = 0.958), followed by Cameriere (ICC = 0.944) and Demirjian (ICC = 0.914).Conclusion: All three methods performed well, but Willems' method was the most accurate and closest to chronological age, which may be an indication of reliability for dental age estimation in this study population.Clinical significance: Accurate age assessment is critical for evaluation of growth, treatment planning, and forensic applications.These results advocate that the Willems method is a reliable tool for age estimation in North Indian children.