Springer Nature is making Coronavirus research free. View research | View latest news | Sign up for updates

Applicability of pulp/tooth ratio method for age estimation


The purpose of this study was to evaluate the reliability of the tooth/pulp ratio method in the process of age estimation at the moment of death in a forensic context and compare it with standard anthropological methods. After the exhumation of mass graves located in sites in Batajnica, Serbia, in 2002 and 2003, skeletal material was thoroughly analyzed by a group of anthropologists and pathologists. As a part of the investigation, orthopantomography (OPG) was performed for each individual. During 2018 these OPGs were reexamined for scientific purposes. Age-at-death was assessed by means of the pulp/tooth ratio method applied to all available lower premolars. Estimated age following standard anthropological methods and chronological age (obtained after DNA identification of victims) was taken from the records. Age estimation using the pulp/tooth ratio and standard methods was compared with chronological age. The pulp/tooth ratio method was accurate in 81.25% of all cases and the standard method was accurate in 56.25% of all cases. The pulp/tooth ratio method of age estimation was found to be applicable and accurate. However, age estimation should be based on all available methods.

This is a preview of subscription content, log in to check access.

Fig. 1


  1. 1.

    Marquez-Grant N. An overview of age estimation in forensic anthropology: perspectives and practical considerations. Ann Hum Biol. 2015;42:308–22.

  2. 2.

    Cunha E, Baccino E, Martrille L, Ramsthaler F, Prieto J, Schuliar Y, et al. The problem of aging human remains and living individuals: a review. Forensic Sci Int. 2009;193:1–13.

  3. 3.

    Johanson G. Age determination from human teeth. Odontol Revy. 1971;22:40–126.

  4. 4.

    Gustafson G. Age determination on teeth. J Am Dent Assoc. 1950;41:45–54.

  5. 5.

    Lamendin H, Baccino E, Humbert JF, Tavernier JC, Nossintchouk RM, Zerilli A. A simple technique for age estimation in adult corpses: the two criteria dental method. J Forensic Sci. 1992;37:1373–9.

  6. 6.

    Cameriere R, Ferrante L, Cingolani M. Variations in pulp/tooth area ratio as an indicator of age: a preliminary study. J Forensic Sci. 2004;49:317–9.

  7. 7.

    Paewinsky E, Pfeiffer H, Brinkmann B. Quantification of secondary dentine formation from orthopantomograms--a contribution to forensic age estimation methods in adults. Int J Legal Med. 2005;119:27–30.

  8. 8.

    Solheim T. Amount of secondary dentin as an indicator of age. Scand J Dent Res. 1992;100:193–9.

  9. 9.

    Kvaal SI, Kolltveit KM, Thomsen IO, Solheim T. Age estimation of adults from dental radiographs. Forensic Sci Int. 1995;74:175–85.

  10. 10.

    Cameriere R, Ferrante L, Belcastro MG, Bonfiglioli B, Rastelli E, Cingolani M. Age estimation by pulp/tooth ratio in canines by peri-apical X-rays. J Forensic Sci. 2007;52:166–70.

  11. 11.

    Cameriere R, Cunha E, Wasterlain SN, De Luca S, Sassaroli E, Pagliara F, et al. Age estimation by pulp/tooth ratio in lateral and central incisors by peri-apical X-ray. J Forensic Legal Med. 2013;20:530–6.

  12. 12.

    Cameriere R, De Luca S, Aleman I, Ferrante L, Cingolani M. Age estimation by pulp/tooth ratio in lower premolars by orthopantomography. Forensic Sci Int. 2012;214:105–12.

  13. 13.

    Marroquin TY, Karkhanis S, Kvaal SI, Vasudavan S, Kruger E, Tennant M. Age estimation in adults by dental imaging assessment systematic review. Forensic Sci Int. 2017;275:203–11.

  14. 14.

    Cameriere R, Ferrante L. Canine pulp ratios in estimating pensionable age in subjects with questionable documents of identification. Forensic Sci Int. 2011;206:132–5.

  15. 15.

    Djuric M. Dealing with human remains from recent conflict: mass grave excavation and human identification in a sensitive political context. In: Blau S, Ubelaker D, editors. Handbook of forensic anthropology and archeology. New Zork: Routledge; 2016. p. 532–44.

  16. 16.

    Brooks S, Suchey JM. Skeletal age determination based on the os pubis: a comparison of the Acsádi-Nemeskéri and Suchey-Brooks methods. J Hum Evol. 1990;5:227–38.

  17. 17.

    Iscan MY, Loth SR. Determination of age from the sternal rib in white females: a test of the phase method. J Forensic Sci. 1986;31:990–9.

  18. 18.

    Iscan MY, Loth SR. Determination of age from the sternal rib in white males: a test of the phase method. J Forensic Sci. 1986;31:122–32.

  19. 19.

    Lovejoy CO, Meindl RS, Pryzbeck TR, Mensforth RP. Chronological metamorphosis of the auricular surface of the ilium: a new method for the determination of adult skeletal age at death. Am J Phys Anthropol. 1985;68:15–28.

  20. 20.

    Meindl RS, Lovejoy CO. Ectocranial suture closure: a revised method for the determination of skeletal age at death based on the lateral-anterior sutures. Am J Phys Anthropol. 1985;68:57–66.

  21. 21.

    Djuric M, Djonic D, Nikolic S, Popovic D, Marinkovic J. Evaluation of the Suchey-Brooks method for aging skeletons in the Balkans. J Forensic Sci. 2007;52:21–3.

  22. 22.

    Donic D, Duric M, Babic D, Popovic D. Reliability of the individual age assessment at the time of death based on sternal rib end morphology in Balkan population. Vojnosanit Pregl. 2005;62:441–6.

  23. 23.

    Djuric M, Dunjic D, Djonic D, Skinner M. Identification of victims from two mass-graves in Serbia: a critical evaluation of classical markers of identity. Forensic Sci Int. 2007;172:125–9.

  24. 24.

    Komar D. Lessons from Srebrenica: the contributions and limitations of physical anthropology in identifying victims of war crimes. J Forensic Sci. 2003;48:713–6.

  25. 25.

    Schmitt A, Murail P, Cunha E, Rouge D. Variability of the pattern of aging on the human skeleton: evidence from bone indicators and implications on age at death estimation. J Forensic Sci. 2002;47:1203–9.

  26. 26.

    Lee JH, Lee C, Battulga B, Na JY, Hwang JJ, Kim YH, et al. Morphological analysis of the lower second premolar for age estimation of Korean adults. Forensic Sci Int. 2017;281:186e1–6.

  27. 27.

    Anastacio AC. Serras C, Vargas de Sousa Santos RF, Palmela Pereira C. validation of Cameriere's medical-legal age estimation method using seconds premolars in a Portuguese population. J Forensic Legal Med. 2018;60:30–4.

  28. 28.

    Babshet M, Acharya AB, Naikmasur VG. Age estimation from pulp/tooth area ratio (PTR) in an Indian sample: a preliminary comparison of three mandibular teeth used alone and in combination. J Forensic Legal Med. 2011;18:350–4.

  29. 29.

    Chandramala R, Sharma R, Khan M, Srivastava A. Application of Kvaal's technique of age estimation on digital panoramic radiographs. Dentistry. 2012;2:142–7.

  30. 30.

    Azevedo AC, Michel-Crosato E, Biazevic MG, Galic I, Merelli V, De Luca S, et al. Accuracy and reliability of pulp/tooth area ratio in upper canines by peri-apical X-rays. Legal Med. 2014;16:337–43.

  31. 31.

    Cameriere R, Brogi G, Ferrante L, Mirtella D, Vultaggio C, Cingolani M, et al. Reliability in age determination by pulp/tooth ratio in upper canines in skeletal remains. J Forensic Sci. 2006;51:861–4.

  32. 32.

    Cattaneo C, De Angelis D, Ruspa M, Gibelli D, Cameriere R, Grandi M. How old am I? Age estimation in living adults: a case report. J Forensic Odontostomatol. 2008;26:39–43.

  33. 33.

    Karkhanis S, Mack P, Franklin D. Age estimation standards for a Western Australian population using the coronal pulp cavity index. Forensic Sci Int. 2013;231:412e1–6.

Download references


The study was supported by The Ministry of Education, Science and Technological Development of the republic of Serbia, Grant no 45005.

Author information

Correspondence to Danijela Djonic.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Zelic, K., Pavlovic, S., Mijucic, J. et al. Applicability of pulp/tooth ratio method for age estimation. Forensic Sci Med Pathol (2020).

Download citation


  • Age estimation
  • Forensic anthropology
  • Mass grave
  • Adults