Validation of the Dental Age app for automated dental age estimation using Demirjian's method

Introduction Dental age estimation is an essential tool in clinical, orthodontic, and forensic contexts, with Demirjian's method (1973) being one of the most widely used worldwide. Recently, digital resources have been developed to automate this process, such as the Dental Age application (Crescendo Treinamentos Avançados, Brazil), available in English for iOS and Android. The aim of this study was to validate the Dental Age app for dental age estimation using Demirjian's method, by assessing its accuracy in relation to chronological age and its agreement with the manual approach. Methods This retrospective cross-sectional study used a convenience sample of 63 panoramic radiographs of healthy children treated at a university pediatric dentistry clinic in Nova Friburgo, RJ, Brazil, aged 3–16 years. The mineralization stages of the seven left mandibular teeth were classified by an experienced orthodontist. Dental age was estimated in two ways: (I) manual Demirjian's method and (II) automated analysis using the Dental Age app. Chronological age was used as the reference. Performance metrics (Mean Absolute Error—MAE, Mean Squared Error—MSE, Root Mean Squared Error—RMSE, and coefficient of determination— R 2 ) were calculated, and Bland-Altman analysis was performed. Results The sample included 25 boys (40%) with a mean chronological age of 12.4 years (range: 8.2–15.9) and 38 girls (60%) with a mean chronological age of 12.8 years (range: 7.5–15.9). The Dental Age app showed a MAE of 0.92 years, RMSE of 1.29, and R 2 of 0.63, while the manual method obtained a MAE of 0.91 years, RMSE of 1.30, and R 2 of 0.63. Bland-Altman analysis revealed a mean bias of 0.04 years, indicating a high level of agreement between methods. Intraclass Correlation Coefficient was 0.99, indicating excellent agreement between the Dental Age application and the traditional Demirjian method. Conclusion The Dental Age app demonstrated equivalent performance to the traditional method, presenting itself as a practical and reliable tool for dental age estimation in children and adolescents.