INDIAN DENTAL JOURNAL

Offical Publication of Society of Medical Dental & Public Health

AGE ESTIMATION METHODS IN FORENSIC ODONTOLOGY

Akhilesh Chandra1  Rahul Agrawal2 Shalini Gupta3 Archana Agnihotri4 Ruchita Verma5
1
Service Senior Resident 2Assistant Professor Department of Oral & Maxillofacial Pathology Faculty of Dental Sciences, Banaras
Hindu University (BHU), Varanasi, India 3Associate Professor & Head Department of Oral & Maxillofacial Pathology, FODS,
King George‟s Medical University, Lucknow, India 4Lecturer, Department of Oral & Maxillofacial Pathology, Dental College,
Azamgarh, India. 5Senior Lecturer, Department of Oral & Maxillofacial Pathology, Shri Bankey Bihari Dental College and
Research Center, Ghaziabad, (India)
Address for correspondence: Dr. Akhilesh Chandra, 2/29 Rashmi Khand, Sharda Nagar, Lucknow, (U.P.) India- 226002
Email Id: drakhilesh_1979@yahoo.com

ABSTRACT
Age estimation has wide application in forensic medicine. It is used in the crimes, accidents as well as in the
determination of deceased person. Teeth are stable parts of the body and least affected by environmental challenges.
The estimation of age of skeletal remains is one of the most complex challenges for anthropologists. The most
common macroscopic methods are based on dental wear and histological evaluation of bone remodeling. These
methods are often qualitative, require great technical expertise.

KEYWORDS Age Estimation, Forensic Odontology, Radiograph, Dentin Translucency

I NTRODUCTIO - Age estimation is the final

step in the triad of dental profiling after
identification and sex determination. It has wide
application in forensic medicine, and used not only
for identification of deceased person but also in
connections with crimes and accidents.1 The two
types of macroscopic parameters that are useful
indicators of biologic age are; epiphyseal closure
throughout the skeleton and dental age estimation.
The developing dentition is thought to be a useful
indicator of maturation and hence the biological age,
because the teeth are less affected than other body
tissues by environmental insults.2 Dental age
estimation is one of the few measures of physiologic
development that is uniformly applicable from
infancy to late adolescence. After attaining maturity,
teeth continue to undergo changes, making age
estimation possible among adults.3
Dental Age Estimation Methods
Dental age estimation makes use of morphologic,
radiographic, histological, and biochemical methods
to examine age dependant changes in teeth.
A. Age Estimation in Prenatal, Neonatal and
Postnatal Period
The primary tooth germ begins to form at seven
weeks in utero (IU), and the enamel formation of all
deciduous teeth is usually complete by the first year.
Among the permanent teeth, the first molar shows
germ formation at about 3.5-4 months IU. Age
estimation in this group of individuals can be very
accurate. It makes use of histological techniques,
which enable observation of tooth mineralization up
to 12 weeks before it is actually apparent on
radiographs. The „neonatal line' is considered as an
indicator of birth. According to Ciapparelli, the
neonatal line may take up to three weeks after birth to
form. Hence, Bowers warns that a false result may be
produced when one concludes that the absence of the
neonatal line proves that the individual was
'stillborn'.3
B. Age Estimation in Children and Adolescents
Two events that may be used to measure dental age
in children and adolescents are tooth emergence or
'eruption' and tooth calcification. It involves visual
assessment of teeth present in the mouth. The use of
tooth emergence for age estimation should, however,
be limited to deciduous teeth. Their emergence is
under genetic control and is relatively regular,
commencing approximately at six months and
completing by about 2.5 years. In permanent teeth,
the evaluation of radiographs to assess tooth
calcification is a much better alternative, since
calcification of teeth can be observed from
radiographs for a period of several years. It is not
altered by local factors such as lack of space,
infection, etc. The study of tooth calcification also
lets one assess age at periods when no emergence
takes place (2.5 - 6 years and > 12 years). 3

30

Atlas Approach The use of radiographs is
characteristic of techniques using the atlas approach
where the morphologically distinct stages of
mineralization that all teeth share, are observed.
Tooth mineralization stages are less affected by
variation in nutritional and endocrine status and
therefore developing teeth provide more accurate
indication of chronological age.1
a. Schour and Massler's Method: The chart, or
atlas, of Schour and Massler is a classic example of
an atlas approach and was probably the first attempt
at scientific dental age estimation. They described 20
chronological stages of tooth development starting
from four months IU until 21 years of age. The chart
is based on histological sections which permit direct
comparisons with radiographs1 these charts were
improved by Ubelaker, who included data from
additional population studies. Bowers has stressed
that Ubelaker's improved charts should be used for
age assessment, since the original Schour and
Massler chart had serious drawbacks.3
b. Moorrees Method: Moorrees et al divided
dental maturation of the permanent dentition into 14
different stages ranging from “initial cusp formation”
upto “apical closure complete” and designed different
tables for males and females. Anderson et al further
developed the system of Moorrees for all the teeth
including the third molars. The tables they compiled
are considered very comprehensive and can be
applied to a much larger age range of juveniles.1
Scoring System (Demirjian's Method): Demirjian et
al tried to simplify chronological age estimation that
assesses the mandibular left side teeth. The
development of mandibular left teeth was divided
into 10 stages and numbered „0‟ – „9‟. Stage 0
denotes that tooth calcification is yet to begin, stage 5
indicates crown completion while stage 9 represents
completion of tooth calcification (complete formation
of root apex). Based on statistical analysis, they
provided different maturity „scores‟ for each tooth for
different developmental stages and differentiated for
boys and girls. The scores assigned for each 8 teeth
are added and a total maturity score is obtained. The
total is substituted in regression formulas to derive
the chronological age.1
C. Age Estimation in Adults
Age estimation in adults is challenging when
compared to younger age groups. Following
completion of growth, changes in the dentition used
to estimate age are influenced not only by the age of
INDIAN DENTAL JOURNAL
Offical Publication of Society of Medical Dental & Public Health
the individual, but also by numerous endogenous and
exogenous factors, such as disease, nutrition, and
physical strain.
Morphological Techniques
Gustafson's Method: In 1950, Gosta Gustafson
developed a method for age estimation based on
morphological and histological changes of the teeth.
They assessed regressive changes such as: Attrition
(A), Secondary dentine deposition (S), Loss of
periodontal attachment (P), Cementum apposition at
the root apex (C), Root resorption at the apex (R),
Dentine translucency (T). 4, 5, 6 For each of these
regressive changes or variables, different scores
ranging from 0-3 were assigned. This applies that
attrition could have anyone of four scores (AO, A1,
A2, or A3) and similar one of four scores for the
other variables. Adding the allotted score for each
variable (e.g. A3 + S2 + P2 + C1 + R2 + T1= X), a
total score (X) was obtained. It was found that an
increase in the total score (X) corresponds to an
increase in age. Age was estimated using the formula:
Age = 11.43 + 4.56 X. However, the improvements
made by Johanson are widely accepted. Instead of the
original four grades (0-3), he proposed seven grades
(0, 0.5, 1, 1.5, 2, 2.5, and 3). Using these seven
grades, the formula Age = 11.02 + (5.14A) + (2.3S) +
(4.14P) + (3.71C) + (5.57R) + (8.98T) was
suggested.1
Dentine Translucency: In 1970, Bang and Ramm
used only one parameter for estimating age i.e.
dentine translucency and reported significant increase
in root translucency with age. 7 Root dentine starts to
become translucent during the third decade of life,
beginning at the apex and advancing coronally. The
alteration may be due to the decreased diameter of
dentinal tubules caused by increased intratubular
calcification. Hence, the difference in refractive
indices between intratubular organic and extratubular
inorganic material is equalized, resulting in increased
translucency of the affected dentine. Based on tooth
type, a number of regression formulas have been
provided for age estimation.1
Age Estimation from Incremental Lines of
Cementum: Kagerer and Grupe suggested the possi-
bility of age estimation from acellular cementum
incremental lines. This made use of mineralized,
unstained cross-sections of teeth, preferably
mandibular central incisors and third molars. The
authors claimed an accuracy of within 2 to 3 years of
the actual chronologic age.8 In addition to age,
hypomineralized bands in these incremental lines
31

gave an indication of events such as pregnancies,
skeletal trauma, and renal disorders, which could be
accurately dated to an individual's life-history, thus
facilitating identification. Valenzuela and coworkers
(2002) said that cementum apposition showed
particular promise for ageing skeletal remains.9 A
major disadvantage of the above methods of
estimating age in adults is the necessity to extract
and/or section the teeth. While this is possible in the
dead, it is not practical among living adults.
Radiological Techniques
Dental Age by Panoramic Radiographs: Dental age
was assessed by panoramic radiographs according to
the methods proposed by Nolla (1960) and Nicodemo
et al. (1974). In the Nolla method, the stage of
development of the mandibular left teeth of each
child was analyzed and then compared to a series of
standardized drawings depicting 10 stages of tooth
calcification for each gender. Therefore, dental age
estimation was obtained for each patient. A similar
procedure was used for the method proposed by
Nicodemo, et. al. (1974).10 However, this method did
not take the patient‟s gender into consideration.
Kurita LM et al. (2007) conducted a study to evaluate
the applicability of the methods proposed by Nolla
and by Nicodemo and colleagues for assessing dental
age and its correlation to chronological age in
Brazilian population. They found that when the Nolla
method was applied, the mean difference between
true and estimated age for males and females was
underestimated. The use of the method proposed by
Nicodemo and colleagues also resulted in
underestimation, although it was more evident in
male subjects. They concluded that although both
methods proved to be reliable in estimating age, the
use of correction factors is recommended.11
Kvaal’s Method: Kvaal and associates developed a
method that used pulp size measurement of six teeth
(maxillary central and lateral incisor, second
premolar; mandibular incisor, lateral incisor, canine,
and first premolar) observed on periapical
radiographs.12 The measurements included several
length and width ratios such as pulp-root length (P),
pulp-tooth length (R), tooth-root length (T), pulp-root
width at CEJ (A), pulp-root width at mid-root level
(C), pulp root width at mid-point between level C and
A (B), The mean value of all ratios excluding T (M),
mean value of width ratios Band C (W) and mean
value of length ratios P and R (L) were derived.
When six teeth (right or left side) from both jaws are
available, the following regression formula can be
used: Age = 129.8 - 316.4 x M - 66.8 x (W-L).3 The
INDIAN DENTAL JOURNAL
Offical Publication of Society of Medical Dental & Public Health
application of Kvaal‟s dental age calculation
technique on panoramic dental radiographs was
studied by Bosmans N et al. (2004). The researchers
concluded from the study that the application of
regression formula on data obtained from panoramic
radiographs may lead to age estimations which are
comparable to those based on the original technique
i.e. periapical radiographs.12 Meinl A et al. (2007)
aimed the study to explore whether the previously
presented regression formulas could lead to
statistically sound results and to appropriate
repeatability when applied to young individuals.
They concluded that the regression equations
reported by Paewinsky et al and Kvaal et al cannot be
applied to a young sample. The use of these formulas
led to age estimations that are far away from the real
chronological age.13
Biochemical Methods
Amino Acid Racemization (AAR): Helfman and Bada
first suggested a relationship between dentinal age
and the extent of aspartic acid racemization in den-
tine.14 Subsequently, others including Ritz and col-
laborators as well as Ohtani and associates have
explored this biochemical method and found it
suitable for ageing. All humans use amino acids
exclusively in protein synthesis. Aspartic acid is an
amino acid that has a rapid rate of racemization, i.e. it
gets spontaneously converted from one type (L-
aspartic acid) to another (D- aspartic acid) with
increasing age.15, 16 Therefore, there is a constant
change in the ratio of L- and D-aspartic acid at dif-
ferent ages and this D-L ratio may be used for age
estimation.14, 17, 18 Due to constant replacement of pro-
teins in metabolically active tissues (such as liver), no
measurable amounts of D-aspartic acid is found.
However, the D/L ratio can be measured in those
proteins that are synthesized early in life and are not
replaced. Such proteins are found in brain cells,
crystalline lens, bone and teeth. Racemization rate of
aspartic acid is high in root dentine, and therefore,
teeth are a valuable source for ageing using this
method.19 A study was done by Ohtani S et al. (1998)
to estimate the age using AAR in a case of pink teeth.
They found that age estimated using deeply pink
involves risk of underestimating the correct age but
an age closer to the actual one after adequate
cleaning.20 In a study by Ogino T and Ogino H (1988)
the researchers used the AAR method in unerupted
and supernumerary teeth for the estimation of age
and concluded that the method is suitable for the
estimation of age by impacted teeth while in
supernumerary teeth the estimated age deviated
32

considerably from the actual age.5 In another study
Ohtani S et al. (2003) studied the correlation between
the level of D- aspartic acid in dentin and the period
of dentin formation in different types of teeth from
the same individual. They reach on a conclusion that
in elder people racemization in teeth that have been
situated deep in the oral cavity for a long time, is
more influenced by the environmental than by the
period of tooth formation.19
Other Methods
Age Determination by Pulp/Tooth Ratio (PTR) in
Upper Canines in Skeletal Remains: Certain dental
methods investigate the apposition of secondary
dentine, in the study of tooth cross-sections, and X-
rays to study width, height, and pulp area. The study
conducted by Cameriere R et al. (2006) showed that
the PTR method, is not only a useful technique to
assess the chronological age of living persons, but it
is also a reliable tool in the determination of age at
death in skeletal remains. Specifically, age estimation
was very precise in eight mummies aged less than 72
years. The method can be used to provide age
estimation of old subjects, who died over 50, with
great reliability. Therefore, for simplicity and
reliability, this method can also be proposed for age
estimation of historical subjects.21
Correlation between Age and Coronal Movement of
Cementum in Impacted Teeth: In impacted teeth,
depending on age, cementum had a tendency to
overlap the enamel. This may be related to
continually erupting forces which affect the impacted
teeth and may be a mechanism by which the teeth are
protected at the cemento-enamel junction (CEJ). A
study was conducted by Bocutoglu O and Yakan B
(1997) on 48 impacted and 51 erupted maxillary
permanent canine teeth extracted from healthy
patients aged 13-73 years. They found a linear
correlation between age and coronal displacement of
cementum in impacted teeth while there was no
correlation between age and coronal displacement in
erupted teeth. Results of the study indicated that the
cementum in impacted teeth migrated coronally
during the ageing process. The authors suggested that
this phenomenon could be used in forensic dentistry
to determine age.22
Age Estimation by Occlusal Tooth Wear: Yun JI et
al. (2007) found that the modified Kim‟s scoring
system had excellent reliability, and that occlusal
tooth wear had a positive correlation with age.
Estimated ages were within 5 years of actual ages in
63.5% of male subjects, and 64.0% of female
INDIAN DENTAL JOURNAL
Offical Publication of Society of Medical Dental & Public Health
subjects. The accuracy of age estimation was
increased when the subjects were divided into two
age groups and data were re-analyzed.23
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