Age Estimation: A Comparison of Dental And Skeletal Radiological Assessed Age with Chronological Age in Individuals Presented to Forensic Medicine Department Peshawar: A Cross Sectional Study

Abstract

Background:
Age estimation is a critical aspect of forensic and legal investigations, especially in populations where documentation is unreliable or absent. Among the most reliable biological indicators for assessing age are dental and skeletal radiological methods. However, their accuracy can vary across populations due to differences in ethnicity, nutrition, and socio-economic status.

Objective:
To compare dental and skeletal radiologically assessed age with actual chronological age in adolescents and young adults from Peshawar, Pakistan, and to determine which method offers greater accuracy, reliability, and agreement with known age.

Methods:
This cross-sectional study included 150 participants (80 males, 70 females) aged 8 to 20 years. Dental age was determined using Demirjian’s method from orthopantomograms, and skeletal age was assessed using hand-wrist radiographs interpreted via the Greulich and Pyle Atlas. Statistical analyses included mean absolute error (MAE), paired sample t-tests, Pearson correlation coefficients, to assess method accuracy, correlation, and reproducibility.

Results:
The mean chronological age was 14.2 ± 3.1 years. Dental age (mean: 14.6 ± 2.9 years) showed a tendency to overestimate chronological age (MAE: 0.75 years), whereas skeletal age (mean: 14.0 ± 2.8 years) demonstrated a closer agreement (MAE: 0.45 years). Skeletal age had a stronger correlation with chronological age (r = 0.91, p < 0.001) compared to dental age (r = 0.85, p < 0.001). The skeletal method also maintained better consistency across age groups, particularly in the 16–20 years bracket. Gender-based differences were minimal and statistically insignificant. Both methods showed excellent inter-rater reliability (ICC > 0.89).

Conclusion:
Skeletal radiological age assessment using the Greulich and Pyle Atlas demonstrates superior accuracy and correlation with chronological age compared to dental age estimation via Demirjian’s method in the adolescent population of Peshawar.

Keywords: Age estimation, Dental age, Skeletal age,, KPK.