The age estimation by tooth cementum thickness is a method that has been discussed regarding its applicability. The aim of this study was to conduct a systematic review on the use of tooth cementum thickness as a biomarker for age estimation in adults, as well as a meta-analysis to assess the method’s reliability. The search was conducted on Embase, LILACS, PubMed/MEDLINE, SciELO, Scopus, and Web of Science databases. Two independent reviewers used inclusion and exclusion criteria to select and assess relevant studies. For bias risk assessment, a checklist proposed by the Joanna Briggs Institute was applied. Pearson and Spearman correlation coefficients were considered as effect measures for the meta-analysis between tooth cementum thickness and chronological age. Heterogeneity among studies was evaluated using Cochran’s <InlineEquation ID="IEq1"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="414_2025_3426_Article_IEq1.gif" Format="GIF" Height="17" Rendition="HTML" Resolution="72" Type="Linedraw" Width="19" /> </InlineMediaObject> <EquationSource Format="TEX">$\:Q$</EquationSource> <EquationSource Format="MATHML"><math> <mrow> <mspace width="0.222222em" /> <mi>Q</mi> </mrow> </math></EquationSource> </InlineEquation> test (<InlineEquation ID="IEq2"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="414_2025_3426_Article_IEq2.gif" Format="GIF" Height="16" Rendition="HTML" Resolution="72" Type="Linedraw" Width="62" /> </InlineMediaObject> <EquationSource Format="TEX">$\:p<0.05$</EquationSource> <EquationSource Format="MATHML"><math> <mrow> <mspace width="0.222222em" /> <mi>p</mi> <mo><</mo> <mn>0.05</mn> </mrow> </math></EquationSource> </InlineEquation>), I2 index, and Graphic Display of Heterogeneity plot. Meta-analysis robustness was assessed using Baujat plots, and publication bias was checked using DOI plots and the Luis Furuya-Kanamori index. Most selected studies showed low risk of bias. Although not all studies were included in the meta-analysis, moderate heterogeneity was found among those included. The synthesized result indicated that tooth cementum thickness has a moderate correlation with chronological age, both when the outlier study is included (<InlineEquation ID="IEq3"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="414_2025_3426_Article_IEq3.gif" Format="GIF" Height="19" Rendition="HTML" Resolution="72" Type="Linedraw" Width="136" /> </InlineMediaObject> <EquationSource Format="TEX">$\:r=0.59\:[0.48;0.69]$</EquationSource> <EquationSource Format="MATHML"><math> <mrow> <mspace width="0.222222em" /> <mi>r</mi> <mo>=</mo> <mn>0.59</mn> <mspace width="0.222222em" /> <mo stretchy="false">[</mo> <mn>0.48</mn> <mo>;</mo> <mn>0.69</mn> <mo stretchy="false">]</mo> </mrow> </math></EquationSource> </InlineEquation>) and when the outlier is removed (<InlineEquation ID="IEq4"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="414_2025_3426_Article_IEq4.gif" Format="GIF" Height="19" Rendition="HTML" Resolution="72" Type="Linedraw" Width="136" /> </InlineMediaObject> <EquationSource Format="TEX">$\:r=0.57\:[0.45;0.68]$</EquationSource> <EquationSource Format="MATHML"><math> <mrow> <mspace width="0.222222em" /> <mi>r</mi> <mo>=</mo> <mn>0.57</mn> <mspace width="0.222222em" /> <mo stretchy="false">[</mo> <mn>0.45</mn> <mo>;</mo> <mn>0.68</mn> <mo stretchy="false">]</mo> </mrow> </math></EquationSource> </InlineEquation>). It is concluded that tooth cementum thickness represents a potential age biomarker that can be useful in age estimation methods for adults. However, the presented results should be considered cautiously, emphasizing the need for further primary studies.

Applicability of tooth cementum thickness as an age marker: systematic review and meta-analysis

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发表日期：

2025年1月28日

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Mirela Cristina da Silva,
Paulo Henrique Viana Pinto,
Ricardo Henrique Alves da Silva

摘要

The age estimation by tooth cementum thickness is a method that has been discussed regarding its applicability. The aim of this study was to conduct a systematic review on the use of tooth cementum thickness as a biomarker for age estimation in adults, as well as a meta-analysis to assess the method’s reliability. The search was conducted on Embase, LILACS, PubMed/MEDLINE, SciELO, Scopus, and Web of Science databases. Two independent reviewers used inclusion and exclusion criteria to select and assess relevant studies. For bias risk assessment, a checklist proposed by the Joanna Briggs Institute was applied. Pearson and Spearman correlation coefficients were considered as effect measures for the meta-analysis between tooth cementum thickness and chronological age. Heterogeneity among studies was evaluated using Cochran’s $\:Q$ $Q$ test ( $\:p<0.05$ $p < 0.05$ ), I²index, and Graphic Display of Heterogeneity plot. Meta-analysis robustness was assessed using Baujat plots, and publication bias was checked using DOI plots and the Luis Furuya-Kanamori index. Most selected studies showed low risk of bias. Although not all studies were included in the meta-analysis, moderate heterogeneity was found among those included. The synthesized result indicated that tooth cementum thickness has a moderate correlation with chronological age, both when the outlier study is included ( $\:r=0.59\:[0.48;0.69]$ $r = 0.59 [0.48; 0.69]$ ) and when the outlier is removed ( $\:r=0.57\:[0.45;0.68]$ $r = 0.57 [0.45; 0.68]$ ). It is concluded that tooth cementum thickness represents a potential age biomarker that can be useful in age estimation methods for adults. However, the presented results should be considered cautiously, emphasizing the need for further primary studies.