Age Estimation from Bone and Dental Development in Living Individuals for Legal Purposes

Abstract

Introduction: Age estimation of living individuals (unaccompanied minors, asylum seekers, criminal responsibility) requires noninvasive methods combining dental (third molar, tooth cementum) and skeletal (hand/wrist, clavicle) maturation. Accuracy and ethical concerns are debated.
Methods: Systematic review of 32 validation studies (n=10,456, age range 12–25 years) comparing radiological age estimates (Demirjian, Greulich-Pyle, clavicle CT) to chronological age. Reference: documented birth certificate. Primary outcome: mean difference (estimated minus chronological age) in years, proportion within ±1 year.
Results: Dental age (third molar Demirjian) overestimated by 0.3 years (SD 1.1) at age 16–18, but by 0.9 years (SD 1.4) at age 12–14. Hand/wrist (Greulich-Pyle) underestimated by −0.2 years (SD 1.2) at younger ages but overestimated by 0.6 years at >18. Combined dental+skeletal reduced error (mean difference 0.1 years, SD 0.9). Clavicle medial epiphysis (CT) was most accurate for 18–21 years (sensitivity 84% for age >18). Ethical concerns: radiation exposure (clavicle CT 0.04 mSv), false age declaration leading to detention as adult.
Discussion: Combined methods provide reasonable accuracy (68% within 1 year). Single method risks legal errors.
Conclusion: Multifactorial age estimation (dental + hand + clavicle) is recommended for legal purposes when chronological age is disputed.