Dental age estimation by cementum incremental lines counting: A systematic review and meta-analysis.

The estimation of dental age by cementum incremental lines (CIL) is a widely investigated method; however, its reliability remains uncertain. The aim of this article was to assess whether CIL are a reliable biological indicator for estimating dental age. A search was performed in Embase, LILACS, PubMed/MEDLINE, SciELO, Scopus and Web of Science databases using a combination of terms related to the topic. Two independent reviewers used inclusion and exclusion criteria so that relevant articles were selected and evaluated. For the risk of bias analysis, a checklist from The Joanna Briggs Institute was applied. For the meta-analysis, Pearson's Correlation Coefficient between chronological age and estimated age was considered as an effect measure. The heterogeneity of studies was assessed using the Cochran's Q statistical test (p < 0.05), and the publication bias using the asymmetry of the Funnel plot and Egger's linear regression test (p < 0.05). Most selected articles had low risk of bias. Although not all studies were included in the meta-analysis, it demonstrated the presence of high heterogeneity among them. Despite this, the synthesized result indicated that the age estimated by CIL count has a high correlation with chronological age. Furthermore, the graphical analysis suggested the absence of publication bias, which was confirmed by the Egger's linear regression test. Therefore, there is scientific evidence that CIL are reliable in estimating dental age, but the method requires a standardized protocol to be followed, as well as the rigorous choice of the root area to be analyzed.