Forensic Age Estimation

Abstract

Background: Forensic age estimation is requested by courts and other government authorities so that immigrants whose real age is unknown should not suffer unfair disadvantages because of their supposed age, and so that all legal procedures to which an individual's age is relevant can be properly followed. 157 age estimations were requested in Berlin in 2014, more than twice as many as in 2004.

Methods: This review is based on pertinent articles retrieved by a selective search in the PubMed and MEDPILOT databases, supplemented by relevant recommendations and by the findings of the authors' own research.

Results: The essential components of age estimation are the history, physical examination, X-rays of the hands, panorama films of the jaws, and, if indicated, a thin-slice CT of the medial clavicular epiphyses, provided that there is a legal basis for X-ray examinations without a medical indication. Multiple methods are always used in combination, for optimal accuracy. Depending on the legal issues at hand, the examiner may be asked to estimate the individual's minimum age and/or his or her most probable age. The minimum-age concept can be used in determinations whether an individual has reached the age of legal majority. It is designed to ensure that practically all persons classified as adults have, in fact, attained legal majority, even though some other persons will be incorrectly classified as minors.

Conclusion: Forensic age estimation lets courts and other government authorities determine the official age of persons whose actual age is unknown-in most cases, unaccompanied refugees who may be minors. The goal is to carry out age-dependent legal procedures appropriately in accordance with the rule of law. The minimum-age concept is designed to prevent the erroneous classification of minors as legal adults.

Figure 1

X-ray findings in a possible minor (age <18.0 years) with a disputed age, and age assessment parameters. The male person examined was from Somalia and claimed to be 17.5 years old. Medical history and physical examination showed no evidence of developmental disorders. a) The ossification (Oss.) of the hand skeleton (HS) was complete. b) The mineralization (Miner.) of the third molars (M3) was complete. c) The ossification (Oss.) of the medial clavicular epiphyses (MCE) was not complete. Both sides were classified as ossification stage 3a, according to Kellinghaus et al. (22). d) The minimum ages corresponding to the determined developmental stages were 16.1 years old, 17.3 years old, and 16.4 years old (20, 23, 24). The highest minimum age (17.3 years) determines the minimum age of the person examined. The most likely age of the person being examined, according to the relevant median age of stage 3a ossification of the medial clavicles, is 19.5 years old, and the maximum age is 22.3 years (24). Since the minimum age of the examined person is below 18.0 years, a minority status seems possible. Finally, as the minimum age diagnosed falls below the age specified by the person being examined, the assessment evidence is compatible with the age indicated by the person examined

eFigure 1

Eruption stages of third molars (stage A: occlusal surface at least partially covered with alveolar bone; stage B: complete resorption of the alveolar bone on occlusal surface; stage C: penetration of the gingiva by at least one dental cusp; stage D: emergence on the occlusal plane)

eFigure 2

Mineralization stages of the third molars (stage A: calcification of the cusps; stage B: unification of the cusps to an occlusal surface; stage C: incipient formation of the cervical region; stage D: complete formation of the tooth crown; stage E: incipient root bifurcation; stage F: root at least as long as the crown, funnel-shaped root endings; stage G: parallel root canal walls, apical endings still partially open; stage H: complete closure of the root tips)

eFigure 3

Main stages of clavicle ossification (stage 1: non-ossified epiphysis; stage 2: isolated ossified epiphysis; stage 3: partial bony fusion between epiphysis and metaphysis; stage 4: complete bony fusion between epiphysis and metaphysis with definable epiphyseal scar; Stage 5: complete bony fusion between epiphysis and metaphysis without visible epiphyseal scar)

eFigure 4

Substages of clavicle ossification (stage 2a: the length of ossified epiphysis is maximally one-third the metaphysis width; stage 2b: the epiphysis length is between one-third and two-thirds [maximum] the metaphysis width; stage 2c: the epiphysis length is more than two-thirds the metaphysis width; stage 3a: a maximum of one-third of the epiphyseal plate is ossified; stage 3b: between one-third and two-thirds [maximum] of the epiphyseal plate is ossified; stage 3c: more than two-thirds of the epiphyseal plate is ossified)