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. 2025 Jun 3;25(1):886.
doi: 10.1186/s12903-025-06232-7.

Which method can be used to assess chronologic age in children?

İrem Okumuş  1 , İpek Arslan  2 , Sema Aydınoğlu  3 , Dilara Nil Günaçar  4 , Semih Ercan Akgün  5
Affiliations

Which method can be used to assess chronologic age in children?

İrem Okumuş et al. BMC Oral Health. .

Abstract

Backgrounds: Dental age determination methods are employed in forensic cases to estimate the age of unidentified individuals. In situations involving mass disasters or war, however, identification is complicated by the absence of adequate tissue remains. To determine children's dental age (DA) through various methods, assess their accuracy, and explore the relationship between bone trabeculation, chronologic age (CA), and DA using fractal dimension analysis (FDA).

Methods: DA was assessed using the Willems (WDA) and London Atlas (LADA) methods on panoramic radiographs of 900 children aged 6-15 years, with accuracy evaluated via mean absolute error (MAE). From these radiographs, 639 were randomly selected for FDA in six regions of interest (bilateral mandibular condyle, angle of mandible, and body of mandible). FDA was used to measure bone trabeculation and its relationship with sex, DA, and CA was determined. Statistical analyses included paired t-tests, Wilcoxon, Mann-Whitney U, independent samples t-tests, one-way ANOVA, and Kruskal-Wallis tests.

Results: WDA and LADA proved effective in estimating the age of Turkish children, with WDA providing closer CA estimates for ages 10 years and below; LADA performed better for ages over 10 years. WDA was particularly reliable for estimating female ages. Both methods showed a positive correlation between DA and FDA, with FDA values increasing alongside CA. No significant sex differences were observed in FDA values.

Conclusion: Although WDA and LADA effectively determine DA with varying accuracy according to sex, the positive correlation of FDA with CA emerges as a promising study in predicting children's ages.

Keywords: Age determination by teeth; Forensic dentistry; Forensic sciences; Fractals; Panoramic radiography.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethical approval was obtained from the Non-Invasive Clinical Research Ethics Committee of Recep Tayyip Erdoğan University (Decision no: 2022/191). The study was conducted in accordance with the Declaration of Helsinki of 1975, as revised in 2013. Since the participants were under 16 years of age, detailed information about the research was given to the children's parents or legal guardians before the study, and an informed consent form was obtained. Consent for publication: The informed consent forms obtained from the patients included explanatory text for personal or clinical details and identifying images to be published in this study, and written informed consent was obtained for their use. Competing interests: The authors declare no competing interests

Figures

Fig. 1
Fig. 1
Display of region of interest areas determined for fractal dimension analysis measurement on panoramic radiography. A right mandibular condyle (R-CON), B right angle of mandible (R-ANG) and C right alveolar body of mandible (R-COR), D left mandibular condyle (L-CON), E left angle of mandible (L-ANG), F left alveolar body of mandible (L-COR)
Fig. 2
Fig. 2
Process steps for FDA performed using the Image J program. a Image J program, b Cropped ROI, (c) Gauss filter, (d) Subtraction of the blurred image from the original, (e) Adding 128 Gy values to each pixel location, (f) Applying 128 threshold values, (g) Erosion, (h) Dilatation, (i) Inversion, (j) Skeletonization
See this image and copyright information in PMC

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