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

Roberta Pinto (Division of Forensic Dentistry, Faculdade São Leopoldo Mandic)
Maria Eduarda Causs (Division of Forensic Dentistry, Faculdade São Leopoldo Mandic)
Débora Moreira (Division of Oral Radiology, Faculdade São Leopoldo Mandic)
Nikolaos Angelakopoulos (Department of Orthodontics and Dentofacial Orthopedics, University of Bern Division of Forensic Dentistry, Faculdade São Leopoldo Mandic||Brazil)
Ademir Franco (Division of Forensic Dentistry, Faculdade São Leopoldo Mandic Department of Therapeutic Stomatology, Institute of Dentistry, Sechenov University||Russian Federation)

Acta Odontologica Indonesia
2026: December Edition (Article in Press)

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.