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Background  The objective of this study was to evaluate and compare the validity and accuracy of the Willems, Demirjian and Nolla methods in predicting chronological age in a Spanish ethnicity population.    Methods  A sample of 604 orthopantomographs of Spanish children aged 4 to 13 years was evaluated by two independent evaluators. Descriptive statistics were applied to calculate the chronological age and dental age, presenting the mean and standard deviation. The difference between dental age and chronological age was calculated for each method. A positive result indicated an overestimation and a negative figure indicated an underestimation. The Wilcoxon test for paired data and Spearman’s correlation coefficient were applied by age groups and sex to compare the chronological age and dental age of each method (that of Willems, Demirjian and Nolla). Statistical tests were performed at a 95% confidence level.    Results  The interexaminer agreement was 0.98 (p = 0.00), and the intraexaminer agreement was 0.99 (p = 0.00). The Willems method significantly overestimated the age of boys (0.35 years (0.93)) and girls (0.17 years (0.88)). The Demirjian method significantly overestimated the age of boys (0.68 years (0.95)) and girls (0.73 years (0.94)). The Nolla method significantly underestimated age in boys (0.44 years (0.93)) and girls (0.82 years (0.98)).    Conclusions  In the Spanish population, the use of the Demirjian method for legal and medical purposes is frequent. This study reveals that the Willems method is more appropriate due to its greater precision in estimating dental age.

Accuracy assessment of dental age estimation with the Willems, Demirjian and Nolla methods in Spanish children: Comparative cross-sectional study